Immediate placement of a thoracostomy tube is indicated if negative pressure cannot be achieved with needle thoracocentesis, if large amounts of blood are aspirated, or if repeated thoracocenteses are required to maintain negative pleural pressure.

 

Figure 30.  Anatomic Orientation for Chest Tube Placement. 

Figure 30 shows correct placement of a chest tube on the lateral aspect of the chest in a dog, with the tube penetrating the skin at the 9th to 11th intercostal space (ICS), tunneling cranioventrally to penetrate the chest wall at the 7th to 8th ICS, directed toward the olecranon of the elbow. Photo courtesy of Dr. Tim Hackett.