chest tube insertion, Step by Step

1. Positioning patient; ideally with the arm on the side of the lesion behind patient’s head for optimal exposure of the axillary region
2. Identify safe triangle and insertion site, 5th intercostal space in the midaxillary line
3. Aseptic technique must be applied
4. Local anaesthesia.
5. Skin incision parallel to the rib
6. Blunt dissection over the rib to avoid vascular or nerve damage
7. Proceed until the pleural cavity is reached
8. Drain insertion and positioning (aim apically for pneumothorax or basally for fluid)
9. Apply stay and (future) closing suture
10. Connect drain to drainage system
11. Apply transparent dressing