I wanted to do a little blurb about the pigtail kit at Community. I often find that we as providers become pretty comfortable with what we know and uncomfortable with any tools we haven't used before. Back in July, I had to do a chest tube at Community, and the kit was totally different (and rest of the procedure was completely different because of this). This kit is not saldinger technique, and doesn't require use of needles (though you still should use lido obvs). I was initially confused when I was looking at the kit, and so wanted to write this out in case you face the same!
The kit comes with a 14Fr pigtail, trocar, long blade that goes in trocar (looks like a hollow bore needle, but isn't!), 11 blade, tubing, three way stopcock, and one way air valve. The main difference from the pigtail kits that we're used to, is there is no guidewire and no needle! Meaning, you're not going in with the needle first.
Essentially, you will end up inserting the pigtail with trocar and long blade in one piece, into the incision site. The trocar is placed in a larger fenestrated hole towards the end of the pigtail.
The steps for the procedure include;
Confirm the location, fool (pick the side with the pneumo, and do it in the triangle of safety)
Prep the site with chlorhexadine
Anesthetize the site with lido
Get sterile
Drape and re-prep (you could probably prep once, but I'm a little OCD)
Combine the pigtail, trocar, and long blade as shown in image
Make your incision above the rib with the 11 blade
Taking the combined long blade, in trocar, in pigtail - insert at your incision, aimed towards the lung apex
Remove the long blade once you pass the resistance of the pleura
Advance the trocar and pigtail, before removing the trocar and continuing to advance the pigtail to the desired depth (usually around 15-20 cm)
Suture the pigtail in place and place a dressing over it
Attach the tubing with the one way valve or to a pleurovac
Now for those of you that may read this and say "omg, I'm not trying to just stab someone," well, you are not alone. Others have commented the same. And if you are so inclined to place this pigtail using saldinger technique, that is still possible. You will need to crack open a central line kit and pillage the needle, syringe, and guidewire. The trocar in the Wayne Pneumothroax tray is hollow bore, and the guidewire can still be fed through that. Hope this was helpful!