- Prep, drape, LA, mark space, position arm above head
- Triangle of safety - pec major and LD lateral edge, axilla hair line/base and 5th ICS
- USS to guide to where fluid is
- Above rib space to avoid NV bundle
- Skin incision small
- Insert needle and syringe - aspirate pleural fluid
- Remove syringe and insert wire - keep wire in hand at all times
- Remove needle then insert dilator 12F
- Remove dilator then insert 12F chest drain
- Hold drain, attach drain to USWD below patient and remove wire
- Secure drain with silk suture
- Dressings - to protect entry site and secure proximal drain to patient
- Lollipop to avoid kinking
- CXR to confirm placement