Stabilize your needle, do not advance further. When you see air bubbles (or fluid) in the syringe, you’ll know your needle is in the pleural space. Draw up a few cc of saline into a syringe, attach to the guide needle, and insert over the 2nd rib at a 60 degree angle while aspirating.Feed the rigid longer stylet into the pigtail to straighten it for insertion.Clean the insertion site, gown up, drape the patient, administer local anesthesia.Position the patient with the head of the bed elevated at 30-60 degrees and their ipsilateral arm raised up over their head if possible, place them on the monitor, provide supplemental O2.I could not find any evidence of increased risk for damage to the mediastinum or subclavian vein or artery on anterior approach despite proximity to these structures. There may also be less subcutaneous tissue to go through anteriorly than on the sides, and I’ve been told it is more comfortable for patients, though an anterior scar may also not be cosmetically preferable. However, many thoracic surgeons prefer to place pigtails in the 2nd intercostal space midclavicular line for a pneumothorax given that air rises. Site selection: The most common site for chest tube placement is in the 4th or 5th intercostal space in the midaxillary line, and this site works fine for pigtail catheters as well. Pleur-evac or other chest tube drainage system.Size 0 silk suture (pro tip from thoracic surgery - because the 2-0 silk included in the kit often breaks).

Chloraprep (if you like to use more than the 1 included in the kit).

The Wayne pneumothorax pigtail catheter kit pictured below (stocked in both Resus and the cardiac room).

Indications: simple pneumothorax (spontaneous or non-penetrating trauma), malignant effusion, parapneumonic effusion (not empyema or hemothorax) Here is a review of the procedure, inspired by Drs. In addition to paging thoracic surgery, you get set up to do a pigtail catheter. On bedside ultrasound, he has absent lung sliding on the right, and CXR confirms a large pneumothorax without midline shift, pictured above.

He has a normal HR and BP but SpO2 is 92% on non-rebreather at 15lpm. A patient presents 3 days after a lung biopsy with shortness of breath and chest pain.

Chest tube pleur evac