• 
  

  • Prolonged drainage of air or fluid (eg, empyema, hemothorax) from the pleural space.

  
  

  • Definitive treatment of a tension pneumothorax (after needle decompression).

Relative

• 
  

  • Bleeding diathesis.

  
  

  • Mechanical ventilation.

  
  

  • Presence of adhesions: may require pleurodesis.

• 
  

  • Sterile gloves, mask, and gown.

  
  

  • Iodinated skin preparation with sterile sponges.

  
  

  • Sterile towels.

  
  

  • Local anesthetic (1% lidocaine without epinephrine).

  
  

  • 5-mL syringe with 25-gauge needle.

  
  

  • 18-gauge 2-inch needle.

  
  

  • #10 scalpel with handle.

  
  

  • Chest tube and Kelly clamp for large bore insertion.

  
  

  • Pleurevac or other drainage system, including all connectors necessary to connect to chest tube and to suction.

  
  

  • Suction.

  
  

  • Needle holder.

  
  

  • Suture scissors.

  
  

  • 2-0 silk suture.

  
  

  • 4 × 4 gauze.

  
  

  • Transparent occlusive dressing.

• 
  

  • Bleeding.

  
  

  • Infection.

  
  

  • Pain.

  
  

  • Pneumothorax.

  
  

  • Puncture of organ (ie, lung, liver, spleen).

• 
  

  • Patient should have intravenous access.

  
  

  • Oxygen should be available.

  
  

  • Monitor oxygen saturation with pulse oximetry.

  
  

  • Younger patients may need sedation or anesthesia for procedure, especially with large bore chest tube insertion.

  
  

  • Explain procedure in a developmentally appropriate manner before and during procedure.

• 
  

  • Patient lying on bed with head of table elevated 30 degrees with arm above head.

• 
  

  • Neurovascular bundle is under the rib (Figure 21–1).