March 2025

In this VETgirl online veterinary continuing education blog, we review how to place a thoracostomy tube – aka “chest tube” – in a dog using the over-the-wire, modified-Seldinger technique. Placing thoracostomy tubes quickly and methodically in the emergent or critically ill patient is a valuable skill for veterinary professionals to learn to keep patients stabilized when afflicted with air (e.g., pneumothorax) or fluid (e.g., pyothorax, hemothorax, chylothorax, etc.) in the pleural space. Patients are often heavily sedated or even anesthetized for this procedure, but with practice you can more easily place them in awake patients if needed!

Patients are typically placed in lateral recumbency with appropriate monitoring and oxygen (e.g., flow by, etc.).

1. First, pre-measure the length of the chest tube from around the 8th intercostal space (intercostal space may vary depending on reference) to the olecranon process or second rib.

2. Shave and aseptically prepare the lateral thorax. Sterile technique is used for the remainder of the procedure. A sterile drape may be used to cover the fur surrounding your prepared site.

3. Within the 8th intercostal space, your insertion point will be just dorsal to the halfway point between sternum and spine. Insert the over-the-needle introducer catheter through the skin, erring closer to the cranial aspect of the rib to avoid blood vessels and nerves running along the caudal aspect of the ribs. Advance the introducer catheter into the pleural space; once in place, removing the stylet and prepare for wire placement.

Photo courtesy of Amy Kaplan-Zattler, DVM, DACVECC, MRCVS

4. Next, using sterile technique, advance the guidewire through the catheter. The guidewire does not need to be advanced to the full length of the guidewire; remember it is meant only to “guide” the chest tube to its intended location. There are no formal units of measurement on the guidewire, so insertion tends to be by visual assessment during insertion.

*Pro Tip – to help keep the guidewire tip from contacting non-sterile fur, it is helpful to enlist an assistant (wearing sterile gloves) to grip the exposed tip of the guidewire.

Photo courtesy of Amy Kaplan-Zattler, DVM, DACVECC, MRCVS

5. The guidewire should now be sitting within the pleural space; next, remove the introducer catheter off the guidewire and then advance the dilator over the wire into the pleural space. This step may take a bit of gentle manipulation to insert the dilator through the skin and intercostal muscles. A small skin incision may help in advancement of the dilator through the skin.

Photo courtesy of Amy Kaplan-Zattler, DVM, DACVECC, MRCVS

6. Remove the dilator off the guidewire and advance the chest tube over the guidewire into the pleural space to the premeasured distance, ensuring all fenestrations are within the pleural space (NOTE: If fenestrations are present within the subcutaneous space, fluid or air may accumulate in this area, which is not appropriate and can result in complications). During this step, have your assistant grip the tip of the guidewire as it exits out the chest tube allowing you to feed the catheter off the guidewire within the pleural space and preventing advancement of the guidewire further into the pleural space. *Be sure to clamp your chest tube to prevent inadvertent air from entering into the chest.

Photo courtesy of Amy Kaplan-Zattler, DVM, DACVECC, MRCVS

7. Secure the chest tube to the skin with anchors and suture (These are often provided in the thoracostomy tube kit). For unstable patients, a rapid evacuation of air and/or fluid through the newly placed tube may be necessary to stabilize the patient prior to securing the tube in place.

8. Confirm and document chest tube placement with thoracic radiographs. Once appropriate placement has been confirmed, a sterile, thin, clear dressing (e.g., Tegaderm) and light bandage/wrap can be carefully place on the patient.

Photo courtesy of Dr. Justine Lee, DACVECC, DABT

You can find additional VETgirl continuing education videos on placing chest tubes, setting up the Pleur-evac system to your chest tubes, or review managing patient care of chest tubes HERE.

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