Teaching Residents Chest Tubes: Simulation Task Trainer or Cadaver Model?

Table 1

Objective assessment checklist of critical steps in chest tube insertion.

Critical Element	Criteria Met	Criteria Not Met
1. Identify insertion site 5th intercostal anterior mid-axillary line on affected side or nipple line (not in females)
2. Sterile preparation of chest
3. Anesthetize skin and subcutaneous tissue and periosteum of underlying rib and pleura just past the rib
4. 2-3 cm incision, transverse incision parallel to the line of ribs, at the predetermined site with a 11 blade scalpel
5. Bluntly dissect the subcutaneous tissue with a hemostat or scissors
6. Dissect over the top of the underlying rib to the next highest intercostal space
7. With the tip of the hemostat puncture the parietal pleura while pushing at the top border of the rib
8. Enter the pleural space over the top of the rib to avoid damaging the neural vascular bundle
9. Enter in a controlled fashion to avoid laceration to the lung
10. Once inside the pleura, spread the hemostat widely and withdraw while still open
11. Create a sufficient opening in the pleura for the chest tube
12. Place finger inside hole of pleura and move finger 360 degrees to confirm correct location and assure no impediment and adhesions
13. Clamp distal end of the chest tube (proximal optional)
14. Connect to an underwater seal collection chamber
15. Secure chest tube
Total Points