diameter At this point, any fluid or air under pressure in the pleural space may surge out Use your gloved finger to explore the tract and remove the curved hemostat, exploring the pleura to ensure that the lung falls away from pleural wall and to clear adhesions or clots Extreme care should be taken when inserting your finger if rib fractures may be present As shown in Figure 130.24D , grasp the chest tube between the tips of the curved hemostat or clamp In general, the smaller thoracic cavity in children as compared with that of adults makes the use of a trocar more risky Advance the instrument loaded with the chest tube through the incision and previously dissected tract to the pleural space When the tube tip has entered this cavity, open the hemostat and advance the tube posteriorly, in the apical direction, until it meets some resistance The tip will most likely be at the apex of the hemithorax Insertion depth can also be estimated prior to inserting the tube by holding the tip of the tube at the clavicle and measuring the length of tube required to reach your incision site Approximate the incision with several silk or nylon sutures, some of which should encircle the tube to secure it in place Antibiotic ointment and a sterile occlusive dressing should be applied to the wound Further taping will help prevent dislodgment Attach the tube to the pleural drainage system (e.g., Pleurevac), and obtain an upright or decubitus chest radiograph INSERTION OF A THORACOSTOMY CATHETER— SELDINGER TECHNIQUE Indications Evacuation of a pneumothorax Drainage of pleural effusion Note that the catheter will not work well for empyema or blood Complications Bleeding (local and/or perforation of major vessels) Pulmonary contusion Hemothorax Infection (insertion site or empyema) Bronchopleural fistula or pleurocutaneous air leak Laceration or perforation of visceral organs (heart, lungs, diaphragm, spleen, liver, or other intra-abdominal organs) Subcutaneous emphysema Re-expansion pulmonary edema Intercostal neuralgia/neuritis