Placement of a thoracic drain trocar

Learn the step-by-step process of placing a thoracostomy trocar tube. Start by preparing the lateral thorax and making a skin incision at the 10th or 11th intercostal space. Then, measure and mark the drain length (from approximately the 10th intercostal space to the elbow). Ensure there is free tube movement around the trocar, and place an inline clip prior to placement. At this point there are three different approaches to placing the tube:

1. Advance the tube and trocar subcutaneously to the 7-8th intercostal space, seat the trocar tip between the ribs, and drive the tube into the thorax. Make sure to hold the tube correctly at this point to prevent lung damage on entry, and direct the tube cranially and ventrally.
2. Alternatively, create a subcutaneous tunnel by asking an assistant to pull the skin cranially after you have made the skin incision, and before drain insertion.
3. It is also possible to perform a mini-thoracotomy incision for drain placement which may reduce the risk of iatrogenic damage to the lungs compared to closed trocar drain placement.

After insertion of the tube, close the inline clip, advance the tube to the pre-measured point, attach air-tight devices, evacuate the thorax to negative pressure and secure the drain with a fingertrap suture.