Bougie-Assisted Chest Tube

A brief video demonstrating the use of a bougie to get that chest tube in the right place the first time in those patients where there is anticipated difficulty. (Disclaimer: Proper PPE and actual human are warranted for proper placement)


  • Obesity
  • Subcutaneous Emphysema
  • Anticipated difficult placement


  • Possible faster time to definitive chest tube placement
  • Helps ensure proper posterior / superior positioning
  • Minimizes number of violations of the parietal pleura


  • Watch your depth - use a marking pen on the bougie approximating dept using the chest tube to avoid over-insertion and possible mediastinal injury
  • If stuck in soft tissue, gently turn the chest tube over the bougie to advance through the chest wall

While no studies we could find compare the method to traditional chest tube placement, we are glad to join the ranks of other bougie enthusiasts at EmCrit and LITFL and thanks to Dr. Rod Fontenette for his idea for the video.