2. Patient preparation:
(a) 床頭搖高 30~60 degrees & Abduction of ipsilateral arm (i.e. over head)
(b) 置放前先測量預訂深度: Insertion site至到clavicle (?Mid or distal)
3. 一定要把所有的side-holes放進pleural cavity; 只要管子在pleural cavity內, 任何的位置都可以引流blood, fluid以及air (air & fluid that is not loculated will follow the path of least resistance & enter a functioning drainage tube as the lung expands and the pleural space becomes smaller)
4. Anesthesia: GENEROUS local anesthesia (max: 4(7)mg/kg) should be given along the entire anticipated track of the tube's passage; (參考NEJM video)
5. Skin incision要夠長 (at least 4 cm, 用No. 10 blade scaplel)且通常在1~2根肋骨低於預進入的ICS
6. Pleural penetration通常是最痛的 (故居部麻醉時要麻到); Opening in the parietal pleura should be wide enough to comfortably insert a finger AND the tube; however an extensive pleural opening should be avoided to prevent subcutaneous emphysema
7. 永遠要確認pathway的patency! (不管是用手指或器械); 故把Kelly移除之前一定要留一根手指在pleura的洞口, 該根手指也可作為放置tube時的導引 (避免subcutaneous dissection with tube)
8. 用Kelly夾chest tube時要確保Kelly的金屬段不會跑出來(以免傷到lung)