Every primary care physician should be familiar with three methods of draining fluid or air from the pleural cavity. These methods are: (1) the insertion of a needle or Intracath catheter into the pleural space; (2) a tube thoracostomy using a Trocar catheter; and (3) a tube thoracostomy using a large intercostal tube. Complete anesthesia can be obtained with lidocaine, remembering that the intercostal nerve runs on the undersurface of the rib above. The Intracath catheter for removal of air is inserted in the second interspace anteriorally. The tube thoracostomy, using the Trocar catheter, is best done through the fourth interspace in the anterior axillary line but can be done wherever the exploratory needle shows the major fluid and air collection to be. The tube thoracostomy, using a large intercostal tube, is best done through the fourth intercostal space at the anterior axillary line. The intercostal catheter or tube should be fixed to the chest wall with sutures and then led to an underwater seal for collection of the contents of the pleural cavity.
