It's so funny to see this thread today because I had my first chest tube complication last nite...at least since I was an intern and used to put them anywhere but inside the chest.
80 yo F spontaneous PTX. Stable but I love chest tubes and I always do them in the ED when I get the chance. I usually make a tiny incision, track my index finger into the pleural space and guide the tube cephald into the apex. Have had no complications since a surgery resident showed me this technique during a trauma code in my 2nd year. Anyway uneventful procedure, good woosh, easy placement, hook up the pleurovac and...nothing. Sats actually start dropping and I'm getting kinda antsy. (One reason is that I'm already getting slammed w/ patients - this was my first pt of the day. As I'm getting everything set up I realize that my tech/nurse had brought me a thoracotomy tray instead of a chest tube tray. I'm looking down, see rib spreaders and thinking...WTF!? So no tube, petroleum guaze, etc, etc. 20 min delay while someone finds me the right kit). So she starts to wake up and is still pretty dyspneic. I reposition the tube 3-4 times, no success. STAT portable chest and the tube is kinked about 180 degrees, essentially folded back onto itself. PTX completely resolved, though. Weird. There was no resistance, no difficulty advancing tube whatosever. Finally just yanked it and placed a 2nd one in the same site w/o any trouble but I've never even heard of that happening before. Kinking yes, but I've never seen a tube bend like that. Of course this whole process took about 90+ minutes in my single cover ED and I got hammered for the rest of my shift. Good times.
I agree w/ advice above. I keep my finger in the hole and guide the tube through w/ my off hand to ensure proper placement. I also direct the tube posteriorly (perpindicular to the floor) and cephalad and it almost always get right up into the apex.
Cheers.