Page 47 - PJ MED OPS Handbook 8th Ed

11. Option for securing chest tube: wrap base of tube on chest wall with occlusive dressing (can use
chest seal), or gauze if no occlusive material is available. Wrap duct or surgical tape around tube
low against chest wall. Leave tail of duct tape and fold back on itself so there is a 2–3 inch tail of
duct tape with no sticky side. Staple or suture tape to chest wall snug so tube does not move.
12. Tape/staple tube more inferior as well so that it is retained alongside of the patient.
PJ PEARLS:
• If time and tactics do not permit, perform a finger thoracostomy. Perform the same steps
as above, but, after the chest wall is penetrated with a clamp, do the finger sweep, let the
blood drain, and seal the incision with an occlusive material. Repeat as needed.
• In MCI, or tight time and space, place (stuff) a glove into an open or sucking chest wound
up to the rib to create an occlusive chest seal, or duct tape a glove/IV bag/Ziploc, etc. over
sterile dressing.

NOTE: Do not place a chest tube into a chest wall defect from injury. Perform tube and finger
thoracostomies in a separate, uninjured site.

Options for chest tube management:
1. Clamp and drain intermittently. If clamped, closely monitor for recurrent tension pneumothorax.
2. Attach one way valve (commercial or improvised) and drain to gravity.
3. Apply low continuous suction if available.
4. Apply “turkey baster” with low pressure suction and leave in place. Can re-engage suction as
needed, or every 1–4 hours.
5. Make every effort to measure volume of blood drainage and document amount and time.
6. Use a one-way valve if flying.

NOTE: Any patient who has undergone a finger or tube thoracostomy, or any other invasive
procedure including cricothyroidotomy, fasciotomy, etc. requires Ertapenem if they have not
already received it.

Chapter 6. Surgical and Medical Procedures n 45