Seldinger ("pigtail") chest tube placement

Essential equipment

AntisepticLocal anestheticPigtail drain kit (18-gauge needle, guidewire, scalpel, dilator, and catheter)Chest tube drainage system (e.g. Pleur-evac)Suture (e.g. 0 or 1-0 silk)Dressing material

Steps

  1. Appropriately position the patient (ipsilateral arm up and behind head).

  2. Administer anxiolytics or systemic analgesia/anesthesia, as indicated.

  3. Sterilize the field. Appropriately drape the area and don sterile gloves.

  4. Identify landmarks (fifth rib, triangle of safety).

  5. Generously administer local anesthetic. Infiltrate superficial and deep tissues.

  6. Advance introducing needle with attached syringe in a straight line over the top of the fifth rib until air or fluid is aspirated.

  7. Advance the guidewire through the needle and into the pleural space. Remove the needle.

  8. Incise the skin at the site of wire insertion with a scalpel. Make an incision large enough to accept the dilator and pigtail catheter.

  9. Advance the dilator over the wire. Remove the dilator while leaving the wire in place.

  10. Advance the pigtail catheter over the wire through the dilated tract. A twisting motion may be needed to advance the catheter through the subcutaneous tissue. The catheter will assume its pigtail configuration when it is in the pleural space.

  11. Remove the guidewire.

  12. Attach the catheter to a chest tube drainage system.

  13. Appropriately secure the catheter and cover with an occlusive dressing.

  14. Order a chest X-ray to confirm placement.