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A chest drain can be placed during thoracic surgery using an open technique. This drain includes a trocar.
A stab incision is made in the skin separate to the thoracotomy site, typically at least 5cm behind the surgical incision, to allow the creation of a subcutaneous tunnel and drain entry at least one space typically behind the thoracotomy incision.
The drain is placed through the incision and pushed along a subcutaneous tunnel.
The drain is lifted, placed over the intercostal space and fingers within the thorax limit the depth of insertion. The handle of the trocar is held within the palm of the other hand and pushed firmly down within the drain.
The drain can be seen emerging into the pleural place.
The catheter is withdrawn leaving the drain in pleural space.
The drain is pulled into position, typically the tip is taken towards the thoracic inlet if drain placed caudal to the incision or towards the costophrenic angle if the drain is place caudal to the incision.
A soft thoracic drain can be used without a trocar.
The tip of the drain is grasped using long forceps and pushed through the subcutaneous tissues.
The drain is pushed bluntly through the intercostal space into the pleural space.
The drain is seen emerging into the depths of the thoracotomy incision.
The drain is seen emerging into the depths of the thoracotomy incision.
