A thoracostomy is a small incision of the chest wall, with maintenance of the opening for drainage. Tube thoracostomy is the insertion of a tube (chest tube) into the pleural cavity to drain air or fluids (blood, bile, pus, or other). The Sydney HEMS trainer work on this procedure and realize a footage of the training that you could find in this article. Thoracostomy is a fundamental procedure for pre-hospital emergency care, and usually the training are done on animal model. Here is a recommended open ‘finger’ thoracostomy technique for ventilated patients as taught by Dr Geoff Healy at Sydney HEMS Team Induction training August 2015, using porcine tissue.

Drainage of the pleural cavity is achieved by the surgeon making a primary incision in the skin followed by a second incision through the muscle between the ribs. This way a tube may be guided into the chest to allow for drainage. Chest tubes are designed to collect this drainage and prevent anything from leaking back into the pleural space. This is accomplished by a check valve, usually part of a specialized drainage system.

Depending on the amount of air/fluid to be drained, the collection bottle may need to be periodically changed.

A thoracostomy is commonly confused with thoracotomy, which is a larger incision commonly used to gain access to organs within the chest.

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