Research Article
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 | | |
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