Modified Seldinger technique for catheter thoracostomy

(A) A needle attached to a partially filled syringe of saline is advanced over the rib at the proposed site of insertion. Air or fluid is aspirated when the needle is in the pleural space.
(B) A guide wire is advanced through the needle into the pleural space.
(C) The needle is removed, leaving the guidewire in place. A small incision is made where the guidewire enters the skin. The scalpel (eg, #11) should be oriented with the blade facing away from the wire to avoid cutting it.
(D) If needed, a dilator may be advanced into the pleural space over the guidewire. The dilator is removed, leaving the guidewire in place.
(E) The thoracostomy catheter is passed into the pleural space over the guidewire. (The guidewire is then removed, and the catheter is secured in place.)