Management of chest drains: A national survey on surgeons-in-training experience and practice

Abstract

Background:Chest tube insertion is a simple and sometimes life-saving procedure performed mainly by surgical residents. However with inadequate knowledge and poor expertise, complications may be life threatening.Objective:We aimed to determine the level of experience and expertise of resident surgeons in performing tube thoracostomy.Methodology:Four tertiary institutions were selected by simple random sampling. A structured questionnaire was administered to 90 residents after obtaining consent.Results:The majority of respondents were between 31 and 35 years. About 10% of respondents have not observed or performed tube thoracostomy while 77.8% of respondents performed tube thoracostomy for the first time during residency training. The mean score was 6.2 ± 2.2 and 59.3% of respondents exhibited good experience and practice. Rotation through cardiothoracic surgery had an effect on the score (P = 0.034). About 80.2% always obtained consent while 50.6% always used the blunt technique of insertion. About 61.7% of respondents routinely inserted a chest drain in the Triangle of safety. Only 27.2% of respondents utilized different sizes of chest tubes for different pathologies. Most respondents removed chest drains when the output is <50 mL. Twenty-six respondents (32.1%) always monitored air leak before removal of tubes in cases of pneumothorax. Superficial surgical site infection, tube dislodgement, and tube blockage were the most common complications.Conclusion:Many of the surgical resident lack adequate expertise in this lifesaving procedure and they lose the opportunity to learn it as interns. There is a need to stress the need to acquire this skill early, to further educate and evaluate them to avoid complications.

Drenagem torácica:

“…Após a colocação do dreno, é indicada a realização de uma radiografia de tórax posteroanterior para confirmação da posição apropriada do tubo. 16,19,20 Uma vez inserido, o tubo deve ser conectado a um sistema de drenagem de forma imediata. Estes, por sua vez, conectam o dreno a um selo d'água que permite a retirada de fluido ou ar, sem permitir que os mesmos sejam reabsorvidos para dentro da cavidade torácica.…”

“…A técnica de dissecção romba é o método preferido para toracostomia tubular. 16 Após a incisão de 1,5 a 2,0cm de comprimento ou o suficiente para que o atendente consiga inserir o dedo no tórax do paciente, é utilizada uma pinça Kelly para cortar as camadas subcutâneas e os músculos intercostais, atravessando o tubo diagonalmente em direção ao próximo espaço intercostal superior. Deve-se deslizar o instrumento, a fim de encontrar as bordas das costelas superior e inferior e chegar até a pleura parietal com o instrumento de dissecção, ou digitalmente, para evitar perfurações do tecido pulmonar adjacente.…”

Safety of the anterior approach versus the lateral approach for chest tube insertion by residents treating spontaneous pneumothorax: a propensity score weighted analysis

“…1 Thoracostomy is an essential procedure that junior and senior residents must perform. 2 A tube thoracostomy is performed after a physician evaluates a plain chest radiograph or chest computed tomography (CT) image of the pneumothorax. 1 However, complications sometimes occur in patients who have undergone a thoracostomy by a resident, even though the resident is supervised by attending doctors.…”

Is Bedside Ultrasound Useful for Chest Tube Removal? Description of an Initial Experience

“…In the case of pneumothorax, the tube can be safely removed when bubbling or fluctuation in the water-seal chamber ceases during expiration or during a cough. 2 Current recommendations for chest tube removal include a chest X-ray before and after the procedure. However, as bedside ultrasound is getting routinely used on daily practice couldn't it be used as a safe tool for checking pulmonary expansion after thoracostomy tube removal?…”