Train Yourself: Getting a Hand on Chest Tube Thoracostomy

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Try this homemade method of ensuring proper placement.

Chest tube thoracostomy is a procedure that all ED providers must feel comfortable doing. Regardless of the setting, this can be an emergent, life-saving procedure that needs to be practiced depending on the frequency a provider does them.

To prevent losing skills in between exposures, we have created an easy to build and low-cost trainer. There already exist simulation trainers for chest tubes that emphasize proper placement, with less emphasis on hand tying the tube in place.


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Many chest tubes fail because they are inappropriately secured after being placed. Hand tying sutures to secure chest tubes is a skill infrequently done in the emergency department.

If the chest tube falls out, patients are then at increased risk of hypoxia due to the underlying mechanism and increased rate of infection when an additional tube needs to be placed.

Proper hand tying requires practice, and this simple trainer can assist with creating a more secure tie and fewer complications for the patient.


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During a teaching shift in the ED working with students and residents, we went to the storage room where we were able to create this trainer within a total of five minutes.

Once they started using the trainer we quickly saw the increased confidence and mastery of this simple, but seldom practiced skill.

Items required for Chest Tube Securing model:

  • Tissue Box
  • 14 Fr All-Purpose Urethral Catheter
  • Tape
  • 0-0 Silk suture
  • Needle driver
  • Pickups
  • 10 mL Syringe or ET tube or Chest Tube

Assembly for Chest Tube Securing model:


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Step 1: Empty tissue box

train yourself step 1

Step 2: Cut the catheter in half

train yourself step 2

Step 3: Lay the catheters across the top, taping them on the sides of the tissue box

train yourself step 3

Step 4: Insert Syringe/Chest tube between the middle of the catheters

train yourself step 4

Step 5: Practice securing the tube with a purse-string suture, going through the catheters like skin

train yourself step 5

Step 6: Practice securing the tube with hand ties

train yourself step 6

ABOUT THE AUTHORS

Ricardo Hernandez, MD is a third-year EM Resident at the AdventHealth Orlando Residency.

Casey McGillicuddy, MD, MPH is a second-year EM Resident at the AdventHealth Orlando Residency.

Kevin Tomescek, MD is the Clerkship Director and Faculty at the AdventHealth Orlando Residency.

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