How to Place a Chest Tube Using the Modified Seldinger Technique | VETgirl Veterinary Continuing Education Videos

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November 2024

In this VETgirl online veterinary continuing education video, we demonstrate how to place a thoracostomy tube – aka “chest tube” – in a dog using the over-the-wire, modified Seldinger technique. Placing chest tubes quickly and methodically in the emergent or critically ill patient is a valuable skill for veterinary professionals to learn as it helps keep patients stabilized that are afflicted by pleural fluid or air accumulation.

Generally, patients are under sedation or anesthesia and positioned in lateral recumbency. The intended chest tube length is measured from the 8th intercostal space to the olecranon process or second rib. The lateral thorax is aseptically prepared, and sterile technique is used for the remainder of the procedure. At the 8th intercostal space, just dorsal to the halfway point between sternum and spine, insert the over-the-needle introducer catheter through the skin, erring closer to the cranial aspect of the rib, and advance into the pleural space before removing the stylet. Next, advance the guidewire through the catheter. Remove the introducer catheter off the guidewire and then advance the dilator over the guidewire and into the pleural space – you may need to make a small skin incision to facilitate advancement of the dilator. Remove the dilator off the guidewire and advance the chest tube over the guidewire into the pleural space to the premeasured distance, ensuring all fenestrations are within the pleural space. If fenestrations are present within the subcutaneous space, fluid or air may accumulate in this area and can result in complications. Secure the chest tube to the skin (e.g., finger trap suture, wire, whatever you find works for you and secures it carefully!), and then obtain radiographs to assess placement position within the chest. Please note: For instructional purposes, medical specimens were used in this video.

You can find additional VETgirl continuing education videos on placing chest tubes, setting up the Pleur-evac system to your chest tubes, or review managing patient care of chest tubes HERE.

This specialized education is brought to you by an exclusive partnership between VETgirl and the BluePearl EmERge program. The BluePearl EmERge program is an immersive emergency veterinarian training program, putting you on the fast track to becoming a highly experienced, confident, and capable emergency veterinarian, ready to provide lifesaving care for pets in need. The program gives you everything you need for a successful career in emergency medicine, including the critical, hands-on experiences, immersive training and personal mentorship needed to thrive. The EmERge program is for new graduates or practicing veterinarians interested in transitioning to emergency medicine. For more information about the program visit https://careers.bluepearlvet.com/us/en/emerge-program.

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