Procedural Skills for Medical Students
Thoracostomy, chest tube
Objectives:
1. Learners should be able to verbalize the
indications and contraindications for
thoracostomy chest tube placement.
2. Learners will be able to demonstrate proper
thoracostomy using sterile technique on the HPS.
Material to review prior to lab: Video on Chest-Tube
Insertion (need access to New England Journal of
Medicine, available to students through the
University of Arizona Health Sciences Library)
Indications:
1. Any significant pleural effusion, hemothorax, chylothorax, or pneumothorax nonresponsive to thoracentesis.
2. Post-operative risk of a pneumothorax or hemothorax.
3. Spontaneous pneumothorax affecting the patient’s ability to breathe.
Contraindications:
1.
2.
3.
4.
Uncontrolled coagulopathy or extreme thrombocytopenia (unless life threatening)
Pulmonary, pleural, or thoracic adhesions
Loculated pleural effusion or emphysema
Skin infection over the chest tube insertion site
Equipment: HPS, thoracostomy tray, chest tube drainage system
Instructional Procedure & Endpoints:
1. Learners will be oriented to HPS, trainers, and equipment in ASTEC.
2. ASTEC staff will demonstrate proper technique for chest tube thoracostomy.
3. Learners will verbalize landmarks for insertion of thoracostomy tube and possible
complications.
4. Learners will demonstrate placement of sterile chest tube thoracostomy insertion.
References:
Dev, S.P., Nascimiento, B., Simone, C., & Chien, V. (2007). Chest-tube insertion. The New
England Journal of Medicine, 355(e21). Retrieved from
http://www.nejm.org/doi/full/10.1056/NEJMvcm071974#figure=preview.gif
Savage, S. (2011). Tube thoracostomy and emergency needle decompression of tension
pneumothorax. In J.L. Pfenninger, & G.C. Fowler (Eds.), Procedures for Primary Care,
3rd Ed (1451-1456). Philadelphia: Elsevier Mosby.
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