Yesterday I presented the problem of the malpositioned chest tube, specifically one that is not completely in the pleural space. This one is wayout:
So what do the doctor books say? Well, the first thing you will discover if you try to look it up is that THERE IS NO LITERATURE ON THIS COMMON PROBLEM! There are a few papers on tubes placed in the fissure and tubes inserted into the lung parenchyma. But there are only a few mentions of tubes with holes still outside the chest.
I’ve gotten a number of comments, including “you can push them in a little”, “take it out and put in another”, and “never push them in.” Since we don’t have any science to guide us, we have to use common sense. But remember, I’ve shown you plenty of examples where something seems reasonable, but turns out to be ineffective or downright harmful.
There are three principles that guide me when I face this problem:
Prevention is preferable to intervention
Do no (or as little as possible) further harm
Tomorrow, I’ll finish this series and provide some tips and guidelines to help manage this problem using the principles outlined above.
This short (10 minute) video demonstrated the technique for inserting small chest tubes, also known as “pigtail catheters.” It features Jessie Nelson MD from the Regions Hospital Department of Emergency Medicine. It was first shown at the third annual Trauma Education: The Next Education conference in September 2015, for which she was a course director.
Please feel free to leave any comments or ask any questions that you may have.
There’s lots of info out there on how to put a chest tube in. But what about on taking it out? There are a few nuances that you should be aware of so you can do this as quickly and complication-free as possible.
Have a look at this 5 minute video and let me know what you think. Please leave your comments on YouTube.
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