THORACOSTOMY

Operative Technique

Patient supine if possible upright, if can tolerate sitting with arms held high on the head

Asepsis and antisepsis technique

Sterile drapes palced

Lidocaine injected subcutaneously at area of incision,

Level of 6^th rib anterior axillary line

Transverse incision made directly over 6^th rib anterior axillary line

Kelly curve forcep passed just above 6^th rib AAL and inserted through 5^th intercostals space anterior axillary line, entering pleural space

Incision digitally explored, assess pleural adhesions, etc and to make incision wide enough to allow thoracic catheter to pass.

Thoracic catheter inserted through 5^th intercostal space, anterior axillary line

Thoracostomy tube attached to a closed suction drain (thora-bottle)

Tube secured with silk 0 sutures

Betadine paint

Vasilinized sponge applied

OS pack

Leukoplast applied