Evaluation of performance of two different chest tubes with either a sharp or a blunt tip for thoracostomy in 100 human cadavers

Ortner, Clemens; Ruetzler, Kurt; Schaumann, Nikolaus; Lorenz, Veit; Schellongowski, Peter; Schuster, Ernst; Salem, Ramez M.; Frass, Michael

doi:10.1186/1757-7241-20-10

Cited by 13 publications

(8 citation statements)

References 25 publications

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“…To our knowledge the only detrimental effect of BMI previously shown has been a study assessing time to completion which was detrimental with increased BMI 13 . In our analysis, an increased BMI ≥ 30 is associated with an increased angle of insertion, as to which causes or contributes to complications remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Tube thoracostomy

Hernandez

Laan²,

Zimmerman³

et al. 2016

Journal of Trauma and Acute Care Surgery

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Introduction Tube thoracostomy (TT), considered a routine procedure, has significant complications. Current recommendations for placement rely on surface anatomy. There is no information to guide operators regarding angle of insertion relative to chest wall. We aim to determine if angle of insertion is associated with complications of TT. Methods We performed a retrospective review of adult trauma patients who necessitated TT at a level I trauma center over a 2 year period (January 2012 – December 2013). TT performed intraoperatively or using radiological guidance were excluded. Thoracic anteroposterior (AP) or posteroanterior (PA) radiographs were reviewed to determine the angle of insertion of TT relative to the thoracic wall. A previously validated classification method was utilized to categorize complications. Descriptive and univariate statistics were used to compare angle of insertion and complicated vs uncomplicated TT. Results Review identified 154 patients who underwent a total of 246 TT placed for emergent trauma. All patients had a post-procedural chest x-ray. We identified 90 complications (37%) over the study period. 144 of the TT’s reviewed had an angle of insertion less than 45 degrees of which there were 27 complications (19%). 102 of the TT’s had an angle greater than 45 degrees and 63 complications (62%), P<0.0001. Conclusions Tube thoracostomy insertion is inherently dangerous. Placement of TT using a higher angle of insertion greater than 45 degrees is associated with increased complications. Further prospective studies quantifying TT angle of insertion on outcomes are needed. Level of Evidence Level IV therapeutic study.

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Section: Discussionmentioning

confidence: 99%

Tube thoracostomy

Hernandez

Laan²,

Zimmerman³

et al. 2016

Journal of Trauma and Acute Care Surgery

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“…In our study 31% of units had only chest tubes with trocars, while 38% of units had both trocar and non-trocar chest tubes. Ortener et al have shown that chest drain insertion with trocars to be associated with a 6-14 % operator related complication rate [3]. No difference in the average performance time could be found between the two techniques.…”

Section: Discussionmentioning

confidence: 99%

“…However, non-availability of equipment has been highlighted as a cause of iatrogenic complications in UK [2]. Furthermore, the use of chest drains with sharp trocar tips have been found to cause a 6-14% increase of operator-related complications [3]. British Thoracic Society (BTS) guidelines have listed out the required equipment for the safe insertion of a chest drain and also recommended the use of blunt dissection and the use of chest drains without trocars [4].…”

Section: Introductionmentioning

confidence: 99%

Adequacy of equipment available for the insertion of chest drains in tertiary care units in Sri Lanka: a multi center study

Harischandra¹,

Hewage²,

Amarashriyan³

et al. 2018

Sri Lanka j Surg

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Introduction Insertion of a chest drain is a common, potentially life-saving procedure, and most doctors will be required to insert a chest drain at some stage of their career, regardless of their specialty. Complications can occur during this procedure that can be life threatening. Not having the required equipment at the crucial time has been highlighted as an important cause of iatrogenic complications. Objectives Our objectives were to formulate a checklist of items required for the safe insertion of chest drains and to assess the adequacy of the equipment available for the procedure within the tertiary care setting of Sri Lanka based on this checklist. Methods A checklist was compiled based on the British Thoracic Society guidelines with modifications according to the Sri Lankan setting. This was further modified after a consensus from an expert panel using the Delphi technique. This checklist was used to perform a descriptive cross-sectional study within tertiary care units in Sri Lanka selected using a multi-staged sampling technique. Results A checklist was formulated consisting of 10 items in the units and nine items in a chest drain pack. Twenty nine units were assessed from five tertiary care hospitals of five provinces of Sri Lanka: Although 75.9% units had designated "chest drain insertion packs", the mean availability of instruments inside them were 52.5%. Only 73% of units had curved instruments to facilitate safe insertion of a drain. Only 7% of units had more than one pack. The availability of equipment required to be easily available within the unit was 94.8%. However, only 24% units used the safer non-trocar chest drain exclusively. Conclusions There is a deficiency of organized instruments and especially non-trocar tubes, even in our tertiary care hospitals. This is likely to make chest drain insertion unsafe in the majority of our units. Availability of a "chest drain checklist" among units could guide the nurses to keep available the required equipment at hand and to set up the trolley at short notice.

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“…These are meant to insert in intercostal space after making a small skin incision, without dissecting the intercostal muscles. Although, this makes the procedure fast, there is a higher risk of injury to the intrathoracic organs and as such use of chest tubes with trocars should be discouraged [3,5,6]. Most of the chest tubes are open from one end while the other end is sealed.…”

Section: Commercially Available Chest Tubesmentioning

confidence: 99%

Chest Tubes

Joshi¹

2022

Pleura - A Surgical Perspective

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Insertion of intercostal drainage (ICD) tube is one of the commonest surgical procedure that is life saving in certain circumstances. Although the procedure is being used for long, yet there is no consensus in its management. The procedure is simple to perform but the incidence of the complications, which primarily occur due to improper positioning of the tube and poor post-procedural care, is as high as 40%. It is therefore essential that all clinicians should be familiar with this simple, common and lifesaving procedure. This chapter provides a comprehensive overview of various aspects of intercostal drainage including the prerequisites, technique of insertion, post-procedural care, complications and common pitfalls in the management of chest tubes in the light of the recent advances and updates.

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Evaluation of performance of two different chest tubes with either a sharp or a blunt tip for thoracostomy in 100 human cadavers

Cited by 13 publications

References 25 publications

Tube thoracostomy

Tube thoracostomy

Adequacy of equipment available for the insertion of chest drains in tertiary care units in Sri Lanka: a multi center study

Chest Tubes

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