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