Saint John EM Rounds – February 2021

Dr Crispin Russell

Thoracic Surgeon, Dalhousie University, Saint John

Trauma Rounds Summary:  January 19 2021 “Chest Tube Management in Trauma – Insights from a Thoracic Surgeon”

Summary – Dr. Andrew Lohoar

Major take home points:

• Most common complication with insertion is advancing tube too far.

• Consider placing tube if pneumothorax is > 10%, lower threshold if transporting patient from peripheral hospital.

• Use 28 French tube for most cases

• Direction you puncture chest wall is generally direction chest tube will follow

• Bigger skin incision may make procedure easier

• “Corkscrewing” or twisting chest tube while placing it, helps ‘feel’ where it is in the chest cavity (avoids advancing too far)

• Post-chest tube insertion CXR is critical to identify placement issues

• Use large volume of local anesthetic (20+ cc) – try to infiltrate parietal pleura

• Consider infiltrating prior to setting up your tray, allowing more time for anesthesia

• Consider holding Kelly clamp with one hand when puncturing pleural, to protect from pushing tip to far into chest. Spread clamp parallel to ribs

• 0 Silk is still preferred for securing chest tube

• Consider tying an ‘air knot’ 1 cm above skin when securing tube, allows easier adjustment later

• Secure chest tube connections with longitudinal taping – stronger and can see joint

• U/S can be used to assist with placement

• Always assess for chest tube functioning post-procedure