Blunt dissection technique for thoracostomy

(A) An incision is made one to two interspaces inferior to the proposed point of thoracostomy tube insertion.
(B) Blunt dissection through the subcutaneous tissue is performed using a clamp.
(C) The clamp is spread after entering the pleural space.
(D) If patient size allows, a probing finger is inserted to confirm entry into the pleural space and to identify the diaphragm and any adhesions. In the presence of rib fractures, the operator should proceed cautiously to avoid injury.
(E, F) The chest tube is gripped with a clamp and inserted (using a finger as a guide if patient size allows using caution to avoid provider injury).
(G) The chest tube is sutured securely in place.