A novel method for improving chest tube insertion skills among medical interns

Photograph depicting the steps of the chest tube insertion on the developed mannequin. A) Equipment preparation, protective measures, identification of the correct site for chest tube insertion and antiseptic application. B) Application of sterile cover and performing local anesthesia; C) incision; D) dissection of subcutaneous tissues in the incision site using a clamp, progression toward the upper costal margin with blunt dissection, accessing the pleura and entering the thoracic cavity with appropriate maneuvers and forming a cavity in the pleura by expanding the clamp when the pleura were entered; E) feeling the pleura by hand along the dissection line. F) Selection of an appropriate size chest tube and grasping this at both ends by clamping. G) Pushing the tube along the dissection line and inserting it by opening the clamp at an appropriate distance. H) Attaching the other end of the clamp to the underwater seal drainage system at an appropriate distance and performing oscillation control. I) Fixing the tube to the chest wall using a ‘U’ suture technique; J) Closure of area, confirmation of tube position with chest x-ray, and disposal of all waste products and hand washing.