The patient shown has a very large left sided spontaneous pneumothorax. You can place any type of drain that you have available including a pigtail or small bore chest tube.
The recommended site for chest tubes and many percutaneous drains is the 4th-5th intercostal space at the anterior axillary line. This location is safer and success rates are higher. If, however, you have the Thora-Vent device, it is designed to go in the 2nd-3rd intercostal space in the midclavicular line. The concern at this site is that you’re in the neighborhood of the heart and great vessels. The metal trocar is long and sharp, and there may be increased risk for injury compared to other sites.
This video demonstrates the use of this device at the 2nd-3rd intercostal space, but could alternatively be placed in the 4th to 5th intercostal space in the anterior axillary line.
The kit contains the Thora-Vent device, a metal trocar, 11 blade scalpel, needles, syringes, and the aspiration cannula. The device has a red diaphragm with a white circle in the middle. Once you enter the chest cavity this will oscillate with respirations. Inside the chamber there is a built-in Heimlich valve.
Prep the skin. Inject your local wheal of anesthetic and into the tract where you will place the catheter. Always aspirate before you inject.
Advance the trocar through the Thora-Vent device and into the silicone catheter. Make a stab incision. And with the center adhesive strip removed from the Thora-Vent, advance the device just over the superior aspect of the 3rd rib to avoid the neurovascular bundle. It does take some force to push this into the thoracic cavity so you want to push from the trocar while bracing it with counter traction so you don’t plunge it into the lung.
As you’re doing this you need to watch the red diaphragm with the white circle. That is going to oscillate when you enter the thoracic cavity. Once in the pleural space, brace the trocar, holding it still while advancing the silicone catheter over the top until you hub it. Once it is flush with the skin you can remove the metal trocar. Remove the drape and attach the adhesive to the patient. No sutures needed.
You can just use the built-in Heimlich valve but we are going to attach the aspiration cannula to remove some of the air more promptly. Connect the 60 ml syringe and aspirate out the air. There’s a one way valve as you aspirate you can push it right back out, which makes a high-pitched sound.
Once no more air is easily aspirated the procedure is complete. Repeat the x-ray, and management after that is the same as with pigtail drains.