Trick of the Trade: Seldinger chest tube technique using bougie

A 40 year-old man presents with a traumatic hemopneumothorax. He weighs 400 pounds.

Chest tubes can sometimes be challenge, especially for those with extra redundant tissue to tunnel through before reaching the intrathoracic cavity. You want to avoid placing the chest tube mistakenly in the subcutaneous space. How can you ensure that your chest tube actually reaches the intrathoracic space?

Trick of the Trade: Chest Tube Technique Using Bougie

Use a bougie as a “stylet” to guide your chest tube

Insert the thinner, longer, and semi-rigid bougie into the intrathoracic cavity. Confirm placement with your finger. Then slide the chest tube over it and remove the bougie. So elegantly simple and effective.

Thanks to the Twitter collective and Dr. Seth Trueger (@MDaware) for the tip! I believe the credit goes to Dr. Charles Maddow (UT Houston).

Author information

Michelle Lin, MD

ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco

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