Again, make sure that the wire itself does not move excessively. Remove the dilator and repeat with the next larger size dilators until all have been used, except for the last one, which carries the chest tube. Step 10 Slide the last dilator with the chest tube over the wire and into the chest cavity until all the holes of the tube are well within the chest cavity. Step 11 Remove the dilator, leaving the patent tube in place, and connect the tube to the drainage system. Step 12 Suture the tube in place.
Some physicians use a purse-string suture to help in closing the incision when the tube is removed.
Step 14 Begin drainage. When a lung re-expands there is some pleural pain, which can be treated with analgesics or intramuscular or intravenous narcotics. Very rapid re-expansion can cause unilateral pulmonary edema, but this complication is rare and usually does not require treatment. If the tube is placed too far into the cavity, the pleural pain it causes can be relieved by withdrawing the tube a few centimetres. When draining large amounts of pleural fluid or blood, temporarily clamp the tube, if possible, after the first litre to minimize large fluid shifts.