February 2025

In this VETgirl online veterinary continuing education blog, we review how to place a trocar thoracostomy tube (e.g., chest tube) in a dog. One of the advantages of the trocar chest tube as compared to the smaller chest tubes is the larger diameter of the chest tube is less likely to clog from viscous fluid (e.g., pyothorax) or from fibrin debris that can form in the prolonged presence of pleural effusion.

To begin, make sure all equipment, sedation and monitoring equipment are in place, and the patient is on oxygen supplementation. Typically with trocar chest tubes, patients are intubated and anesthetized or heavily sedated and placed in in lateral recumbency.

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.

 

Photo courtesy of BluePearl/VETgirl

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. An assistant pulls the skin cranially (Remember “forward skin” or “foreskin!”). The skin will remain in this advanced position until the catheter has been advanced to its full intended length into the pleural space. (Once released, it ‘pulling forward’ of skin will cause a natural tunnel for the thoracostomy tube).

4. Using a scalpel blade, make a skin incision at the 8th intercostal space (intercostal space may vary with reference) at the highest point of the chest between spine and sternum.

 

Photo courtesy of BluePearl/VETgirl

5. Insert the open tips of your hemostats into your skin incision serving as a guide for your scalpel blade, and make a stab incision through the intercostal muscles and pleural lining into the pleural cavity. Remove your scalpel blade but keep your hemostats in position.

 

Photo courtesy of BluePearl/VETgirl

6. Align your chest tube parallel along the hemostats and advance the chest tube into the pleural space while simultaneously removing your hemostats. *Be careful! The trocar tip is sharp!

 

Photo courtesy of BluePearl/VETgirl

7. Once the trocar and distal tip of the chest tube are within the pleural space, gently advance the chest tube off the trocar and towards the cranioventral thorax to the premeasured distance.

8. Remove the trocar and clamp the chest tube lumen immediately to prevent atmospheric air from being pulled into the chest cavity (depending on if the patient is intubated and ventilated, etc.).

 

Photo courtesy of BluePearl/VETgirl

9. The retracted skin can now be released and will create a tunneling of the chest tube under the skin. The tunneling of the chest tube may help reduce the risk of infection, reduce migration of outside air along the tube and into the, and may aid in protecting against tube migration/dislodgement from movement of the patient.

 

Photo courtesy of BluePearl/VETgirl

10. Attach your evacuation mechanism to the chest tube (3-way stopcock, Smart-Y), and then secure the tube with a purse string suture at the skin entry point followed by a finger trap suture pattern up the tube.

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

Photo courtesy of Dr. Justine Lee, DACVECC, DABT

Note with these types of chest tubes, the 3-way stopcock must be TIGHTLY secured to the trocar, or can become disconnected resulting in a fatal tension pneumothorax. With large bore chest tubes, VETgirl’s opinion is that 24-7 care is a must to ensure the tube doesn’t accidentally become dislodged or disconnected.

Check out this VETgirl video for How-To Tie a Finger Trap Suture.

Need to know more…check out this webinar on Nursing Care in Thoracic Trauma.
Now that the chest tube is in…now what…watch this video on How to Set Up a Pleur-evac system.


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