![]() here is a video of pigtail insertion on a mannequin and on a personĬomplications: similar to those seen in larger bore chest tube placement, including bleeding from an intercostal artery (or internal mammary artery if going in the midclavicular line), solid organ injury, diaphragmatic injury, infection, and re-expansion pulmonary edema.Although the placement of chest tubes usually falls to physicians, many healthcare workers-be they paramedics or nurses-have had to care for patients with chest tubes in place, either in a hospital setting or during transport.Get a post-procedure CXR to verify tube placement and lung re-expansion.Attach the pigtail catheter to the drainage bag connector and then to the chest tube drainage system on low wall suction.Secure the catheter with 0-silk similar to securing a chest tube, and cover with xeroform and tegaderm to form an occlusive dressing.Remove the guidewire and stylet simultaneously.Feed the loaded catheter + stylet over the guidewire to the desired depth.Using Seldinger technique (just like central line placement), take off the syringe, feed the guidewire ensuring it advances freely, remove the needle, nick the skin, insert the dilator over the guidewire and through to the pleural space, then remove the dilator.Stabilize your needle, do not advance further. ![]() When you see air bubbles (or fluid) in the syringe, you’ll know your needle is in the pleural space.
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