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:
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Most common complication with insertion is advancing tube too far.
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Consider placing tube if pneumothorax is > 10%, lower threshold if transporting patient from peripheral hospital.
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Use 28 French tube for most cases
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Direction you puncture chest wall is generally direction chest tube will follow
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Bigger skin incision may make procedure easier
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“Corkscrewing” or twisting chest tube while placing it, helps ‘feel’ where it is in the chest cavity (avoids advancing too far)
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Post-chest tube insertion CXR is critical to identify placement issues
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Use large volume of local anesthetic (20+ cc) – try to infiltrate parietal pleura
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Consider infiltrating prior to setting up your tray, allowing more time for anesthesia
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Consider holding Kelly clamp with one hand when puncturing pleural, to protect from pushing tip to far into chest. Spread clamp parallel to ribs
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0 Silk is still preferred for securing chest tube
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Consider tying an ‘air knot’ 1 cm above skin when securing tube, allows easier adjustment later
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Secure chest tube connections with longitudinal taping – stronger and can see joint
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U/S can be used to assist with placement
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Always assess for chest tube functioning post-procedure
