LRH · EMERGENCY DEPARTMENT
Chest Tube / Finger Thoracostomy
INDICATIONAir or blood in the pleural space. Tension physiology or traumatic arrest → finger thoracostomy NOW (bilateral in traumatic arrest) — the tube can follow.
EQUIPMENT
CHEST TUBE KIT — ROOM 7 (RESUS BAY) CABINET · CHEST DRAINAGE
(tube + drain stocked loose on the same shelf)
IN THE KIT — 13 PEEL PACKS (full list + expiry: page 2)
- Both preps — ChloraPrep + povidone-iodine · silk 0 ×2 · scalpel No. 10 · needle + syringe + 25 g · long curved blunt scissors · large needle driver · Kelly large + medium · fenestrated + half drape
NOT IN THE KIT — OFF THE SHELF
- Chest tube — 28–32 Fr blood, 24–28 Fr or 14 Fr pigtail air · primed drain (RN, in parallel — never gates the incision) · PPE (Trauma Cart dr 5) · dressing kit (separate bag) · lidocaine 1% 10–20 mL (Omnicell) if awake
PREP — IN PARALLEL, NOT IN ORDER
- MD — kit, gown/gloves, pick the tube size, prep skin, drape
- RN — lidocaine, antibiotics (Ancef 2 g; clinda 900 mg if PCN anaphylaxis), prime the Pleur-evac, monitor + analgesia
FIG 1 · TRIANGLE OF SAFETY (RIGHT LATERAL CHEST)
STEPS
- Position: supine or 30–45° up, arm abducted / behind the head on the affected side.
- Landmark: 4th–5th intercostal space, anterior-to-mid-axillary line — inside the triangle of safety, above the nipple line. Palpate and confirm.
- Prep + drape; local anesthetic skin → rib → pleura if the patient is conscious.
- Incise 2–4 cm through skin, parallel to and directly over the rib BELOW the target space.
- Blunt-dissect with the Kelly over the TOP of the rib — the neurovascular bundle runs under each rib’s lower edge.
- Punch through the pleura with the closed clamp — expect a give + hiss of air or rush of blood; spread to widen.
- FINGER: insert a full gloved finger, sweep 360° — confirm you are in the pleural space, clear adherent lung. In arrest this IS the complete procedure — do both sides; re-finger if tension recurs.
- TUBE: clamp the distal end; guide the tip through the track with forceps — apical for air, posterobasal for blood. Every fenestration inside the pleura.
- Connect the primed drain — look for fogging, respiratory swing, output. Keep the drain ≥45 cm below the chest.
- Anchor suture + occlusive dressing; mark depth at skin; CXR.
>1500 mL blood out, or >200 mL/hr for 2–4 h → activate MTP + thoracotomy / transfer discussion.
5TH ICS
ANT/MID-AXILLARY LINE
2–4 cm
INCISION, OVER RIB BELOW
1500 mL
OUT → MTP / THORACOTOMY
LRH · EMERGENCY DEPARTMENT · KIT CHECK CARD
Chest Tube Kit
ROOM 7 (RESUS BAY) CABINET · CHEST DRAINAGE · PAR 1 · TAPE THIS CARD BESIDE THE BAG
Contents are the department’s typed kit sheet, 2026-08-14. Check the bag against it.
Thirteen peel packs, thirteen expiry dates — the bag expires on the earliest.
LAST CHECKED
DATE · INITIALS
EARLIEST EXPIRY IN BAG
THE DATE THE BAG EXPIRES
NEXT CHECK DUE
MONTHLY, OR AFTER ANY USE
| QTY | IN BAG | ITEM — ONE PEEL PACK PER LINE | EXPIRY |
|---|
| 1 | | ChloraPrep 10.5 mL swab | |
| 1 | | Povidone-iodine swab | |
| 2 | | Silk 0 sutures | |
| 1 | | Scalpel No. 10 | |
| 1 | | Blunt needle — to draw | |
| 1 | | 10 mL syringe | |
| 1 | | 25 gauge 1½ needle — to inject | |
| 1 | | Long curved blunt scissors | |
| 1 | | Large needle driver | |
| 1 | | Large Kelly clamp — to dissect | |
| 1 | | Medium Kelly clamp — on the tube | |
| 1 | | Fenestrated drape | |
| 1 | | Half drape | |
ALSO NEEDED — NOT IN THE BAG.
Chest tube 28–32 Fr, 24–28 Fr, 14 Fr pigtail, and the underwater-seal drain — loose on the shelf.
PPE — Trauma Cart dr 5. Dressing kit — separate bag. Lidocaine 1% — Omnicell.
The drain never gates the incision — the RN primes it in parallel; finger thoracostomy needs none. An opened pack means the bag is not complete — replace it and re-date this card.