Thoracostomy

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I. Indications

a. Needle thoracostomy indicated for initial management of suspected or documented tension pneumothorax.
b. Tube thoracostomy indicated for drainage of pneumothorax, hemothorax, symptomatic pleural effusion, empyema, and/or chylothorax.

II. Equipment

a. Needle thoracostomy
1. 14 to 16 gauge catheter over needle.
2. 23 gauge butterfly needle ( infants )

b. Tube thoracostomy
1. 28 to 36 Fr thoracostomy tube.
2. For infants and children, see Table a9-1.

c. General
1. Kelly clamps, large and small
2. Scalpel with # 10 blade
3. Needle driver
4. 1-0 silk suture with tapered or cutting needle
5. Suture scissors
6. Thoracostomy tube collection system
7. Sterile syringe and infiltrating needles
8. Tape
9. Sterile 4 x 4 gauze sponges
10. Medication for local anaesthesia and sedation
11. Sterile gloves, gown, mask, cap, drapes
12. Povidone iodine
13. Supplemental oxygen ( cannula, mask other as appropriate )
14. Pulse oximeter
15. EKG monitor
16. Intravenous catheter, tubing, and fluid
17. Resuscitation cart