| Figure 6-5. Standard sites for tube thoracostomy: A.
Second intercostal space, mid-clavicular line, for air. B. Fifth
intercostals space, mid-axillary line, for fluid. |
Figure 6-8. Use of a needle to puncture the pleura and establish
the presence of blood or air in the pleural space. This not
only is diagnostic but also may be a temporary therapeutic maneuver
in a tension pneumothrax. (Redrawn from Richards. V.: Tube
thoracostomy. J. Fam. Pract. 6:631. 1978.) |
| Figure 6-7. Infiltration of skin and pleura with local anesthetic. (Redrawn
from Hughes. W. T. and Buescher. E. S.: Pediatric Procedures. 2nd
ed. Philadelphia. W. B. Saunders Co. 1980. p. 234.) |
Figure 6-9. Location of the intercostals neurovascular bundle. (From
Millikan. J. S. et al.: Complications of tube thoraostomy for acute
trauma. Am. J. Surg. 140:739. 1980.) |
| Figure 6-10. The skin wound is made one intercostals
space below the space through which the tube will pass (A). Blunt
dissection is carried subcutaneoulsy (B) and into the pleural space
(C). A common error in technique is to attempt to insert a
large chest tube through a skin incision that is too small. (Redrawn
from Hughes. W. T. and Buescher. E.S.: Pediatric Procedures. Philadelphia. W.B.
Saunder Co., 1980. p. 237.) |
Figure 6-11. One accomplishes blunt dissection by forcing
the closed points of the clamp forward and then spreading the tips
and pulling back with the points spread. One must be certain
to make an adequate opening in the pleura. (From Bricker. D.
L.: Safe, effective tube thoracostomy. E. R. Reports 2:49-52.
1981.) |
| Figure 6-12. Loading a chest tube on a Carmalt or large Hemostat |
Figure 6-13. Using the finger as a guide, one places the
tip in the pleural cavity. (From Millikan. J. S. et al.: Complications
of tube thoracostomy for acute trauma. Am. J. Surg. 140:739.
1980.) |
