A primary skin incision is made superiorly to the rib to avoid the neurovascular supply that runs inferiorly to the rib. The surgeon will tunnel through the subcutaneous tissue and muscle to penetrate the pleural cavity. This cavity is where a hemothorax or pneumothorax would accumulate. Confirmation of being in the pleural cavity is done and the chest tube is placed. The chest tube is then connected to a Pleur-evac for continuous drainage. A Roman sandal tie and U-Stitch are done to secure the chest tube and to ensure that removal of the tube will not produce another pneumothorax. Chest x-ray is performed post-procedure to confirm placement and to check for resolution of the pneumothorax/hemothorax. 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 with an underwater seal. Depending on the amount of air/fluid to be drained, the collection bottle may need to be periodically changed.
Thoracostomy
Thoracotomy
Video-assisted thoracoscopic surgery
Lobotomy
Pleurodesis
Open lung ventilation
Trachelectomy
Tracheotomy