Is trocar guidance for chest tube insertion a disappearing art?

While blunt dissection is the technique most often used for chest tube insertion, trocar guidance is a safe and effective alternative when used with proper technique in selected patients. In fact, trocar guidance may be the preferred technique in patients who have a tension pneumothorax, a large pneumothorax, a large pleural effusion, or a thick pleural peel surrounding an effusion. Compared with blunt dissection, trocar guidance has the advantages of taking less time and causing less patient discomfort. However, when a chest tube is required for a small pleural effusion or a small pneumothorax, blunt dissection with digital exploration or insertion of a pigtail catheter under CT guidance is preferable to the trocar technique.