FORWARD EMS Chest Tube Insertion Kit, 28Fr

A chest tube emergency kit (also called a tube thoracostomy kit) contains all the equipment needed to insert a chest tube and establish pleural drainage in the field. The FORWARD EMS kit includes:

• Chest tube (28Fr silicone, kink-resistant, radiopaque, fenestrated)
• One-way drainage valve (Heimlich-style) to allow air/fluid out while preventing air ingress
• Surgical instruments: Rochester-Pean forceps for blunt dissection, Kelly forceps for tube guidance, safety scalpel for skin incision
• Antiseptic prep: Chlorhexidine swab sticks for sterile site preparation
• Occlusive dressings: HALO chest seal and petrolatum gauze for sealing the insertion site
• Gauze sponges for hemorrhage control and site care
• Sterile gloves for provider protection

Some kits may also include suture material for securing the tube, though many prehospital protocols use alternative securement methods.

Chest tube insertion (tube thoracostomy) requires the following equipment:

Essential Equipment:

• Chest tube (appropriate size—typically 28-36Fr for adults)
• Scalpel (#10 or #20 blade) for skin incision
• Large curved clamp (Rochester-Pean or Kelly forceps) for blunt dissection through intercostal muscles and parietal pleura
• One-way valve or underwater seal drainage system
• Antiseptic solution (chlorhexidine or povidone-iodine)
• Sterile gloves and drapes
• Occlusive dressing materials
• Suture or commercial tube securement device

Additional Equipment (as available):

• Local anesthetic (lidocaine with or without epinephrine)
• Syringe and needle for local anesthesia
• Tube securement device
• Chest X-ray capability for position confirmation

The FORWARD EMS kit provides all essential components in a single vacuum-sealed package, ready for immediate use in the field.

The "Rule of 4" is a mnemonic for safe anatomical landmarks when inserting a chest tube. It helps providers avoid injury to vital structures like the heart, liver, spleen, and intercostal vessels.

The Rule of 4:

• 4th or 5th intercostal space: This corresponds to the nipple line in males or the inframammary fold in females. Inserting above this level risks injury to major vessels; below risks abdominal organ injury.
• Anterior to mid-axillary line: The insertion site should be in the "Safe Triangle" bounded by the lateral border of pectoralis major (anterior), anterior border of latissimus dorsi (posterior), and nipple line (inferior).

Additional Safety Points:

• Always insert ABOVE the rib (on the superior border) to avoid the neurovascular bundle that runs along the inferior border of each rib
• Use blunt dissection through the intercostal muscles and parietal pleura—never blindly thrust instruments into the chest
• Perform a finger sweep before tube insertion to confirm pleural entry and check for adhesions

Whether paramedics can insert chest tubes depends on their scope of practice, which varies by state, agency, and level of training:

Standard Ground Paramedics: Most state EMS scopes of practice do NOT authorize standard paramedics to perform tube thoracostomy. Instead, they perform needle thoracostomy (needle decompression) for tension pneumothorax, which is within standard paramedic scope nationwide.

Expanded Scope Providers Who May Perform Tube Thoracostomy:

• Flight Paramedics (FP-C, CCEMTP): Many air medical programs authorize tube thoracostomy under expanded scope protocols
• Critical Care Paramedics: Ground CCT programs may authorize under enhanced medical direction
• Tactical Medics (TEMS): Some SWAT medical programs authorize under physician oversight
• Community Paramedicine: Some advanced community paramedicine programs

Requirements for Authorization:

• State scope of practice must permit the procedure
• Medical director must specifically authorize and provide protocol
• Provider must complete didactic, simulation, and clinical training
• Ongoing competency maintenance required

Military Medics: Army 18D Special Forces Medics, 68W Combat Medics with advanced training, Navy SARC, and Air Force PJs are authorized to perform chest tube insertion under TCCC protocols.

Always verify your specific scope of practice with your medical director and state EMS office before performing any invasive procedure.

The FORWARD EMS kit features a medical-grade silicone chest tube instead of the standard PVC tubes found in most kits. Key advantages include:

Kink Resistance: Silicone is inherently more flexible and resistant to kinking than PVC. In prehospital settings where patients are moved, packaged, and transported, tube kinking can convert a successful thoracostomy into a failed intervention. The silicone tube maintains patency even when bent at acute angles.

Biocompatibility: Silicone has excellent biocompatibility with reduced tissue reaction compared to PVC.

Temperature Stability: Silicone maintains flexibility across a wider temperature range—important for operations in extreme cold or heat.

This Matters Because: In the back of a helicopter, ambulance, or during tactical casualty evacuation, the patient's position changes constantly. A chest tube that kinks means air and blood cannot drain, potentially causing recurrent tension physiology despite a "patent" tube site. The silicone tube in the FORWARD EMS kit provides an additional safety margin during transport.

Chest tube size selection depends on the indication and patient factors:

For Pneumothorax (Air Only):

• Smaller tubes (24-28Fr) are generally sufficient
• Some literature supports even smaller tubes (14-20Fr) for simple pneumothorax

For Hemothorax (Blood):

• Larger tubes (32-36Fr) traditionally recommended to prevent clotting and maintain drainage
• Recent evidence suggests 28Fr may be adequate for many cases

For Hemopneumothorax (Both):

• 28-36Fr depending on anticipated blood volume

The FORWARD EMS kit uses 28Fr because:

• Versatile for both pneumothorax and moderate hemothorax
• Easier insertion than larger tubes
• Less patient discomfort
• The kink-resistant silicone maintains effective drainage even at this smaller size

Contact us at customerservice@pacificbiomedical.com if your protocol requires a different tube size—we offer custom kit configurations.

Yes. The FORWARD EMS Chest Tube Insertion Kit is TAA (Trade Agreements Act) compliant and made in the USA. This means it can be purchased by:

• Federal government agencies
• Department of Defense
• GSA Schedule contractors
• State and local government agencies with TAA requirements
• Government contractors

The kit is also FDA registered as a complete medical device kit. Contact us for documentation or assistance with government procurement.

Shelf Life: 3 years from manufacture date (printed on packaging)

Storage Recommendations:

• Store in a cool, dry location
• Avoid extreme temperatures and direct sunlight
• Do not store in areas with high humidity
• Inspect vacuum seal before use—do not use if seal is compromised
• Ideal for ambulance, aircraft, and facility storage
• Suitable for cache storage in remote locations

The vacuum-sealed packaging protects contents during storage and transport, making it ideal for EMS jump bags, aircraft medical kits, and tactical medical pouches.

Yes. Pacific Biomedical offers custom kit configurations to meet your program's specific requirements. Options include:

• Different tube sizes: 32Fr, 36Fr, or other sizes per your protocol
• Additional components: Suture material, lidocaine, additional gauze, etc.
• Alternative chest seals: Vented HALO, HyFin, or other brands
• Custom labeling: Agency-specific labels or lot tracking
• Bulk packaging: Multiple kits per case for inventory management

Contact our team at customerservice@pacificbiomedical.com or call 844.436.3526 to discuss your custom kit requirements.