Securing the Tube

  1. Secure the tube to the patient's skin with the heavy sutures using simple interrupted or mattress sutures. Purse string sutures are not recommended due to poor cosmetic results and increased risk of skin necrosis
  2. The free ends of the sutures are wrapped around the tube and tied multiple times to secure it in place. It must be tied tight enough so that the tube is slightly kinked, but not so tight as to snap the thread.
  3. After securing the tube, wrap the tube with a petroleum based gauze dressing
  4. Apply several pieces of sterile gauze cut in a "Y-cut" fashion around the tube with the Y-cuts at 90o angles to each other
  5. Secure the site with multiple pressure dressings
  6. A CXR must be done to ensure the correct placement of the tube. On x-ray:
    • The radiopaque stripe should be visible, with an interruption indicating the placement of the proximal drainage hole, this hole must be within the pleural space
    • If the interruption lies outside the pleural space, the tube is not draining effectively. In this instance, the tube must be removed and replaced altogether. DO NOT ADVANCE THE TUBE INTO THE CHEST! This will introduce non-sterile tubing into the chest cavity