Ateneo de Zamboanga University College of Nursing Nursing Skills Output (NSO) Report No.

4 Thoracostomy Description: Thoracostomy is the surgical formation of an opening into the chest cavity. It involves insertion of a tube into the pleural space to evacuate air or fluid thus regaining negative pressure. The tubes inserted are strategically positioned in the pleural space, sutured to the skin and connected to a drainage apparatus. Places for insertion of tube are the following: Pneumothorax second or third interspace along midclavicular or anterior axillary line. Hemothorax sixth or seventh interspace in the midaxillary line. Purpose: Used to treat spontaneous pneumothorax, hemothorax or pneumothorax caused by trauma. Equipments and Materials Needed: Tube thoracostomy tray Syringes Needles or trocar Basins Skin germicide Sponges Scalpel Sterile drapes Two large clamps Suture material Local anesthetic Chest tube Connector Drainage system o Connecting tubes o Tubing o Collection bottles commercial system o Vacuum pump if required Sterile water

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Procedure: Needle or IntraCath Technique 1. The skin is prepared and anesthetized using local anesthetic with a short gauge 25 needle. A larger needle to infiltrate the subcutaneous tissue, intercostal muscles and parietal pleura. 2. The exploratory needle is inserted 3. The IntraCath catheter is inserted through the needle into the pleural space. The needle is removed and is pushed several centimeters into the pleural space. 4. The catheter is taped to the skin. 5. The catheter is attached to a connector or tubing and attached to a drainage system.

Trocar Technique A trocar catheter is used for the insertion o a large bore tube for the removal of a modest to large amount of air leak or for the evacuation of serous effusion. 1. A small incision is made over the prepared anesthetized site. Blunt dissection with a hemostat through the muscle planes in the interspace to the parietal pleura is performed. 2. The trocar is directed into the pleural space, the cannula is removed and a chest tube is inserted into the pleural space and connected to a drainage system. Hemostat Technique using a Large-Bore Chest Tube A large bore chest tube is used to drain blood or thick effusions from the pleural space. 1. After skin preparation and anesthetic infiltration, an incision is made through the skin and subcutaneous tissue 2. A curved hemostat is inserted into the pleural cavity and the tissue is spread with the clamp. 3. The tract is explored with an examining finger. 4. The tube is held by the hemostat and directed through the opening up over the ribs into the pleural cavity. 5. The clamp is withdrawn and the chest tube is connected to a chest drainage system. 6. The tube is sutured in place and covered with a sterile dressing. Illustrations:

Nursing Responsibilities: Before the Procedure: 1. 2. 3. 4. 5. 6. Verify patient identity. Assess patient for pneumothorax, hemothorax or presence of respiratory distress. Secure patients X-ray. Ensure that the informed consent has been signed. Assemble the drainage system. Reassure the patient and explain the steps of the procedure. a. Tell the patient to expect a needle prick and a sensation of slight pressure during anesthesia infiltration. 7. Position patient as for an intercostal nerve block or according to physicians preference.