How to Place a Trocar Chest Tube in a Dog

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Free for Elite Members

October 2024

In this VETgirl online veterinary continuing education video, we demonstrate how to place a trocar chest tube in a dog. This procedure is performed in lateral recumbency in the anesthetized or heavily sedated patient. After aseptic preparation of the lateral thorax, an assistant pulls the skin cranially throughout the duration of the procedure; this is typically done while the assistant’s hands are under the drape, away from the sterile field. The skin remains retracted throughout the procedure until final placement is achieved. Use a scalpel blade to make a skin incision at the 8th intercostal space (ICS) and at the level of the highest point of the chest between spine and sternum. Premeasure insertion depth of your chest tube from the cranioventral thorax (i.e., near elbow) to the skin incision. Next, insert the open tips of your hemostats into your skin incision using them as a guide to make a stab incision into the pleural cavity. With your hemostats again acting as a guide, align your chest tube along the hemostats and advance the chest tube while simultaneously removing your hemostats. Be careful, as the trocar tip is sharp. Once the trocar and distal tip of the chest tube are within the pleural space, advance the chest tube off the trocar towards the cranioventral thorax to the premeasured distance. Remove the trocar and clamp the chest tube lumen immediately (to prevent outside air from entering the chest). The retracted skin can now be released by the assistant and will create a tunneling of the chest tube under the skin – this helps to reduce the risk of infection, helps secure the tube, and bolsters the seal around the tube.  Attach your evacuation mechanism to the chest tube (e.g., 3-way stopcock, Smart-YTM) and then secure the tube with suture. Most often a purse string suture and finger trap are utilized for this purpose.  Thoracic radiographs are always recommended post thorocostomy tube placement to assess appropriate placement of the chest tube; if malpositioned, the tube should be adjusted appropriately.  Please note: a medical specimen is used for teaching purposes in this video.

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.

This specialized education is brought to you by an exclusive partnership between VETgirl and the BluePearl EmERge program. The BluePearl EmERge program is an immersive emergency veterinarian training program, putting you on the fast track to becoming a highly experienced, confident, and capable emergency veterinarian, ready to provide lifesaving care for pets in need. The program gives you everything you need for a successful career in emergency medicine, including the critical, hands-on experiences, immersive training and personal mentorship needed to thrive. The EmERge program is for new graduates or practicing veterinarians interested in transitioning to emergency medicine. For more information about the program visit https://careers.bluepearlvet.com/us/en/emerge-program.

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