You should seek the advice of your veterinarian if your pet is ill as only he or she can correctly advise on the diagnosis and recommend the treatment that is most appropriate for your pet.

Correct placement of thoracic drains is important for the successful management of many intrathoracic diseases and post-operative procedures.

There are numerous indications for the placement of a thoracostomy tube for drainage, including :

• Post-thoracic surgery
• Pneumothorax
• Haemothorax
• Pyothorax
• Chylothorax
• Hydrothorax

Selection of fenestrated drain size is based upon body size, and the following can be used as a guideline 

The drain can be placed in a conscious animal using local anaesthetic, and this will be necessary in many patients in which general anaesthesia represents a life-threatening risk. 

Insertion Technique

Local anaesthetic is infiltrated into the skin and subcutaneous tissues between ribs 9 -12, over the area 2 intercostal spaces caudal to the point at which the drain will enter the thoracic cavity (usually the 7/8th intercostal space). An intercostal nerve block is performed 2 intercostal spaces cranial to the intended skin incision. 

The skin is clipped and prepared for aseptic surgery.

The selected drain is cut to length so that it can reach the 1st  intercostal space from the selected point of insertion.

The skin incision is made two-thirds of the way up the chest wall over the intercostal space . A purse-string suture is pre-placed around the skin incision. A large curved pair of forceps is used to grasp the distal (fenestrated end) of the drain, push it through the incision and forwards in a tunnel under the skin to the 7/8th intercostal space where it is pushed bluntly through the intercostal muscles into the thoracic cavity. The drain is advanced 2-3 cm into the chest. If a trocar has been used this is removed, the drain is clamped to prevent air entering the chest, and the drain  is secured to the skin using a Chinese finger trap suture. Once in place air that may have entered the chest cavity during the procedure can be drained from the uppermost part of the chest by using a large syringe and 3-way tap. 

Following this continuous drainage is provided by  :

• Running air-tight tubing from the drain to a drainage bottle, linked in series to an underwater air trap / seal and then on to a suction bottle (with air vent) and suction device. This apparatus is placed 1-2 m below the patient. Suction pressure  is maintained at 5-10 cm water .
• Use of a Heimlich one-way valve for large dogs with pneumothorax. With this device air is expelled from the chest during inspiration but the valve does not allow aspiration of air back into the chest during expiration.

Care of the drain and suction apparatus is important :

• It must be checked regularly for blockages
• It must be checked regularly for breaks in air-tight seals
• It must be checked regularly to ensure it is still in place
• It must be protected from damage and interference by the animal
• Prophylactic use of antibiotics may minimise the risk of infection developing around the tube

Removal of the drainage tube should be rapid, and the purse-string skin suture should be tied quickly and firmly. The tube is removed when drainage of intrathoracic air/fluids stops and lung inflation during inspiration is at it's maximum.

Updated January 2016