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Journal articles on the topic 'Chest tube'

Author: Grafiati

Published: 4 June 2021

Last updated: 1 February 2022

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1

Shalli, Shanaz, Edward M. Boyle, Diyar Saeed, Kiyotaka Fukamachi, William E. Cohn, and A. Marc Gillinov. "The Active Tube Clearance System a Novel Bedside Chest-Tube Clearance Device." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 5, no. 1 (January 2010): 42–47. http://dx.doi.org/10.1097/imi.0b013e3181cf7ce3.

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Objective Chest-tube clogging can lead to complications after heart and lung surgery. Surgeons often choose large-diameter chest tubes or place more than one chest tube when concerned about the potential for clogging. The purpose of this report is to describe the design and function of a proprietary active tube clearance system, a novel device that clears clots and debris from chest tubes. Device Description The active tube clearance system is a novel chest tube clearance apparatus developed to maintain chest tube patency. Chest tube clearance is achieved by advancing the specially designed clearance member back and forth within the chest tube under sterile conditions, breaking down and pulling clots back toward the drainage receptacle, thereby leaving the inner portion of the chest tube clear of any obstructing material. Conclusions By maintaining chest tube patency, chest tube drainage can be performed more safely, and this apparatus may possibly lead to the use of smaller chest tubes and less invasive insertion techniques.

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Theodorou, Christina M., Mennatalla S. Hegazi, Hope Nicole Moore, and Alana L. Beres. "Routine chest X-rays after pigtail chest tube removal rarely change management in children." Pediatric Surgery International 37, no. 10 (June 25, 2021): 1447–51. http://dx.doi.org/10.1007/s00383-021-04951-w.

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Abstract Background The need for chest X-rays (CXR) following large-bore chest tube removal has been questioned; however, the utility of CXRs following removal of small-bore pigtail chest tubes is unknown. We hypothesized that CXRs obtained following removal of pigtail chest tubes would not change management. Methods Patients < 18 years old with pigtail chest tubes placed 2014–2019 at a tertiary children’s hospital were reviewed. Exclusion criteria were age < 1 month, death or transfer with a chest tube in place, or pigtail chest tube replacement by large-bore chest tube. The primary outcome was chest tube reinsertion. Results 111 patients underwent 123 pigtail chest tube insertions; 12 patients had bilateral chest tubes. The median age was 5.8 years old. Indications were pneumothorax (n = 53), pleural effusion (n = 54), chylothorax (n = 6), empyema (n = 5), and hemothorax (n = 3). Post-pull CXRs were obtained in 121/123 cases (98.4%). The two children without post-pull CXRs did not require chest tube reinsertion. Two patients required chest tube reinsertion (1.6%), both for re-accumulation of their chylothorax. Conclusions Post-pull chest X-rays are done nearly universally following pigtail chest tube removal but rarely change management. Providers should obtain post-pull imaging based on symptoms and underlying diagnosis, with higher suspicion for recurrence in children with chylothorax.

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Martínez-Téllez, Elisabeth, Juan Carlos Trujillo-Reyes, Mauro Guarino, Ramón Rami-Porta, and Josep Belda-Sanchis. "Chest tube." ASVIDE 5 (August 2018): 694. http://dx.doi.org/10.21037/asvide.2018.694.

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Amber, Kyle T. "Chest Tube." Chest 143, no. 6 (June 2013): 1832. http://dx.doi.org/10.1378/chest.12-2656.

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Remérand, Francis, Virginie Luce, Yasmina Badachi, Qin Lu, Belaïd Bouhemad, and Jean-Jacques Rouby. "Incidence of Chest Tube Malposition in the Critically Ill." Anesthesiology 106, no. 6 (June 1, 2007): 1112–19. http://dx.doi.org/10.1097/01.anes.0000267594.80368.01.

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Background Malposition of percutaneously inserted chest tubes is considered as a rare complication in critically ill patients. Its incidence, however, remains uncertain. The aims of the study were to assess the true incidence of chest tube malposition in critically ill patients and to identify predicting factors. Methods The authors prospectively studied 122 chest tubes percutaneously inserted in 75 consecutive critically ill patients. For clinical reasons independent of the study, thoracic computed tomography scanning was performed in 63 patients, allowing direct visualization of 106 chest tubes. Based on these findings, chest tube position was classified as intrapleural, intrafissural, or intraparenchymal. Factors predicting chest tube malposition were analyzed by univariate and multivariate analysis. Results The mean delay between chest tube placement and thoracic scan was 3.5+/-2.9 days. Twenty-two chest tubes were diagnosed as being intrafissural (21%), and 10 were diagnosed as being intraparenchymal (9%). The only predicting factor associated with the risk of malposition was the use of a trocar for the percutaneous insertion of the chest tube (P=0.032). Conclusions Malposition was detected in 30% of percutaneously inserted chest tubes, a higher incidence than previously reported. Avoiding the use of a trocar may reduce significantly the incidence of chest tube malposition.

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Torres, Harrys A., Hend A. Hanna, Linda Graviss, Gassan Chaiban, Ray Hachem, Roy F. Chemaly, Essam Girgawy, and Issam I. Raad. "Chest Tube–Related Empyema Due to Methicillin-ResistantStaphylococcus aureus:Could the Chest Tube Be Coated With Antiseptics?" Infection Control & Hospital Epidemiology 27, no. 2 (February 2006): 195–97. http://dx.doi.org/10.1086/501154.

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We reviewed the epidemiology, clinical manifestations, and outcomes of 3 cases of chest tube–related empyema due to methicillin-resistantStaphylococcus aureus(MRSA). Antiseptic-impregnated chest tubes were inserted in cultures containing MRSA isolates from these 3 patients, and zone of inhibition were measured. Chest tube–related MRSA empyema might complicate tube thoracostomy, and coating the chest tube with antiseptic agents could prevent this complication.

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Antanavicius, G., J. Lamb, P. Papasavas, and P. Caushaj. "Initial Chest Tube Management after Pulmonary Resection." American Surgeon 71, no. 5 (May 2005): 416–19. http://dx.doi.org/10.1177/000313480507100510.

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Tube thoracostomy management with suction or water seal after anatomical pulmonary resection remains somewhat controversial. Initial chest tube management may influence the duration of pleural fluid drainage, duration of tube thoracostomy, and/or hospital length of stay following pulmonary resection. We hypothesized that initial chest tube management with water seal decreases time for chest tube removal and decreases time of hospital stay. A retrospective chart review was performed on 109 consecutive patients who underwent lobectomy or segmentectomy in Western Pennsylvania Hospital between December 1999 and December 2003. Comparison was made between chest tube management of water seal or suction in patients with and without air leak. Of the 109 patients, 78 (72%) had no air leak at the completion of surgery, and 31 (28%) had air leak. In the group without air leak (n = 78), water seal was used in 32 (41%) patients and suction in 46 (59%). In patients placed to water seal initially after surgery (n = 32), removal of chest tubes was on postoperative day (POD) 3.19 ± 0.24 and hospital discharge was on POD 5.13 ± 0.61. In patients placed to suction initially (n = 46), chest tubes were removed on POD 4.52 ± 0.40. Hospital discharge was on POD 6.74 ± 0.5. Both duration of chest tube ( P < 0.007) and length of hospital stay ( P < 0.04) were significantly lower in the water seal group. In the air leak group (n = 31), 7 (23%) patients were managed with water seal and 24 (77%) patients with suction. Both duration of chest tube ( P = 0.001) and length of hospital stay ( P < 0.05) were significantly lower in the water seal group. In patients without air leak, chest tubes should be managed with water seal following anatomical pulmonary resection, resulting in significantly shorter chest tube duration and hospital length of stay.

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Ergin, Makbule, Ali Yeginsu, and Kursat Gurlek. "Chest tube insertion." Turkish Journal of Surgery 26, no. 2 (2010): 115. http://dx.doi.org/10.5097/1300-0705.ucd.459-10.01.

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Fitzpatrick, Colleen, and Karen J. Brasel. "Chest tube insertion." Operative Techniques in General Surgery 5, no. 3 (September 2003): 129–33. http://dx.doi.org/10.1016/s1524-153x(03)70003-7.

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Karbhase, Jayant, and Pallavi S. Kadam. "Chest Tube Insertion." MGM Journal of Medical Sciences 5, no. 1 (2018): 31–32. http://dx.doi.org/10.5005/jp-journals-10036-1178.

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Iberti, Thomas J., and Philip M. Stern. "Chest Tube Thoracostomy." Critical Care Clinics 8, no. 4 (October 1992): 879–95. http://dx.doi.org/10.1016/s0749-0704(18)30230-6.

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Panicek, D. M., P. A. Randall, L. S. Witanowski, B. N. Raasch, and E. R. Heitzman. "Chest tube tracks." RadioGraphics 7, no. 2 (March 1987): 321–42. http://dx.doi.org/10.1148/radiographics.7.2.3448638.

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WHITE, ROBIN CASTLE. "Disclosed Chest Tube." Nursing 15, no. 12 (December 1985): 25. http://dx.doi.org/10.1097/00152193-198512000-00008.

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Dev, Shelly P., Bartolomeu Nascimiento, Carmine Simone, and Vincent Chien. "Chest-Tube Insertion." New England Journal of Medicine 357, no. 15 (October 11, 2007): e15. http://dx.doi.org/10.1056/nejmvcm071974.

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Zardo, Patrick, Henning Busk, and Ingo Kutschka. "Chest tube management." Current Opinion in Anaesthesiology 28, no. 1 (February 2015): 45–49. http://dx.doi.org/10.1097/aco.0000000000000150.

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Kinney, MR, KT Kirchhoff, and KA Puntillo. "Chest tube removal practices in critical care units in the United States." American Journal of Critical Care 4, no. 6 (November 1, 1995): 419–24. http://dx.doi.org/10.4037/ajcc1995.4.6.419.

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BACKGROUND: Pain assessment and management are recognized as major problems in critical care settings. However, little is known about pain management practices related to medical procedures performed in the ICU, particularly removal of chest tubes. OBJECTIVES: To describe practices related to chest tube removal in the United States, with an emphasis on pain assessment and management. METHODS: A survey instrument was developed and mailed to 995 members of the American Association of Critical-Care Nurses who cared for patients with chest tubes. They were asked about chest tube removal practices in their institutions. RESULTS: Chest tubes are removed primarily by physicians and house staff, although 11% of respondents reported that specially trained nurses removed the tubes. Only 16% indicated that a prescription for pain medication was routinely available before chest tube removal. The drug administered most frequently was intravenous morphine sulfate, but the dose varied considerably. Nurses were generally satisfied (65.6%) with practices related to chest tube removal in their unit; nurses who were not satisfied (34.4%) wished to see better pain management practices (45%), removal of tubes by the patient's assigned nurse (17.8%), a protocol for tube removal (13.9%), notification of the nurse before removal (12.2%), and other changes (10%). CONCLUSIONS: Practices associated with chest tube removal, especially pharmacologic management of procedure-related pain, vary in critical care units. Caregivers are advised to develop practice policies to guide decisions about management of acute pain in this patient population.

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Kruse, Tamara, Sharon Wahl, Patricia Finch Guthrie, and Sue Sendelbach. "Place Atrium to Water Seal (PAWS): Assessing Wall Suction Versus No Suction for Chest Tubes After Open Heart Surgery." Critical Care Nurse 37, no. 4 (August 1, 2017): 17–28. http://dx.doi.org/10.4037/ccn2017269.

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BACKGROUND Traditionally chest tubes are set to −20 cm H2O wall suctioning until removal to facilitate drainage of blood, fluid, and air from the pleural or mediastinal space in patients after open heart surgery. However, no clear evidence supports using wall suction in these patients. Some studies in patients after pulmonary surgery indicate that using chest tubes with a water seal is safer, because this practice decreases duration of chest tube placement and eliminates air leaks. OBJECTIVE To show that changing chest tubes to a water seal after 12 hours of wall suction (intervention) is a safe alternative to using chest tubes with wall suction until removal of the tubes (usual care) in patients after open heart surgery. METHODS A before-and-after quality improvement design was used to evaluate the differences between the 2 chest tube management approaches in chest tube complications, output, and duration of placement. RESULTS A total of 48 patients received the intervention; 52 received usual care. The 2 groups (intervention vs usual care) did not differ significantly in complications (0 vs 2 events; P = .23), chest tube output (H1 = 0.001, P = .97), or duration of placement (median, 47 hours for both groups). CONCLUSION Changing chest tubes from wall suction to water seal after 12 hours of wall suction is a safe alternative to using wall suctioning until removal of the tubes.

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Hardin, Jeremy, Aaron Strumwasser, Daniel Grabo, John Kleinman, Kenji Inaba, and Demetrios Demetriades. "Evaluation of Single- versus Dual-Tube Thoracostomy after Thoracotomy for Trauma." American Surgeon 83, no. 10 (October 2017): 1142–46. http://dx.doi.org/10.1177/000313481708301026.

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Draining the chest cavity with two chest tubes after thoracotomy for trauma is controversial. This article aims to determine whether using two tubes after thoracotomy for trauma is more effective than using a single tube. A 9-year retrospective review (2007–2015) was performed at our academic level I trauma center. All patients who underwent trauma thoracotomy (unilateral and bilateral) were included for analysis (n = 99). Patients with incomplete data, pediatric patients (age < 18), pregnant patients, and early deaths (<24 hours) were excluded. When analyzed by chest cavity, dual tubes have increased drainage bilaterally (P = 0.008) and require more days to clear the right chest (P = 0.002). Patients with dual tubes bilaterally are associated with increased intensive care unit length of stay (P = 0.05) and ventilator days (P = 0.04). Although dual chest tube insertion achieves greater drainage, it comes at the cost of increased time to clear the chest and is associated with worse outcomes in bilateral injuries. One chest tube may be sufficient post-trauma thoracotomy; routine placement of two chest tubes is not recommended.

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Anand, Rahul J., James F. Whelan, Paula Ferrada, Therese M. Duane, Ajai K. Malhotra, Michel B. Aboutanos, and Rao R. Ivatury. "Thin Chest Wall is an Independent Risk Factor for the Development of Pneumothorax after Chest Tube Removal." American Surgeon 78, no. 4 (April 2012): 478–80. http://dx.doi.org/10.1177/000313481207800441.

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The factors contributing to the development of pneumothorax after removal of chest tube thoracostomy are not fully understood. We hypothesized that development of post pull pneumothorax (PPP) after chest tube removal would be significantly lower in those patients with thicker chest walls, due to the “protective” layer of adipose tissue. All patients on our trauma service who underwent chest tube thoracostomy from July 2010 to February 2011 were retrospectively reviewed. Patient age, mechanism of trauma, and chest Abbreviated Injury Scale score were analyzed. Thoracic CTs were reviewed to ascertain chest wall thickness (CW). Thickness was measured at the level of the nipple at the midaxillary line, as perpendicular distance between skin and pleural cavity. Chest X-ray reports from immediately prior and after chest tube removal were reviewed for interval development of PPP. Data are presented as average ± standard deviation. Ninety-one chest tubes were inserted into 81 patients. Patients who died before chest tube removal (n = 11), or those without thoracic CT scans (n = 13) were excluded. PPP occurred in 29.9 per cent of chest tube removals (20/67). When PPP was encountered, repeat chest tube was necessary in 20 per cent of cases (4/20). After univariate analysis, younger age, penetrating mechanism, and thin chest wall were found to be significant risk factors for development of PPP. Chest Abbreviated Injury Scale score was similar in both groups. Logistic regression showed only chest wall thickness to be an independent risk factor for development of PPP.

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Csonka, Ákos, Dávid Dózsai, Tamás Ecseri, István Gárgyán, István Csonka, and Endre Varga. "Mellkasi sérültek drenázsadatainak vizsgálata." Orvosi Hetilap 160, no. 5 (February 2019): 172–78. http://dx.doi.org/10.1556/650.2019.31252.

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Abstract: Introduction: Chest injuries cause a significant number of pneumothorax (PTX) and hemothorax (HTX). The most commonly used treatment is chest-tube drainage. The position of the tube is a prime necessity to achieve adequate drainage. Aim: To analyze the duration of chest drainage at the occurrence of PTX and HTX. To find what the underlying cause of drainage insufficiency is and whether there is any relation between the surgical qualification needed to the procedure. Method: Clinical data of 110 injured patients from 2011 to 2015 were collected and retrospectively analyzed. In the case of tube breaking or drainage insufficiency it was investigated if repositioning, usage of new tubes or insertion of additional tubes resolved the drainage insufficiency. Authors investigated the location of the tube on x-ray and CT, and the connection between the drainage insufficiency and the surgical qualifications needed to the procedure. Results: The average duration of chest drainage was 6.5 days. The duration of drainage was shorter by 1.9 days regarding the tube inserted in the middle section of the chest compared to the upper one and shorter by 1.2 days regarding the tube inserted in the lower section of the chest compared to the upper one. In the case of HTX, the duration of drainage was shorter by 2.8 days regarding the lower and by 3.6 days regarding the middle section compared to the upper position. Drainage insufficiency occurred in 30% of all cases. The duration of chest drainage was shorter after application of new tubes (9.5 days) than after reposition (10.2 days), but there was no significant difference. Conclusion: Chest injury is a wide entity, thus one standard protocol cannot be developed on the management of these injuries. Authors concluded that drainage duration decreases significantly if the position of the tube is in the middle or lower section of the chest. The high occurrence of drainage insufficiency was caused by inadequate tube positioning and tube breaking. The practical qualification of trauma surgeons did not play a significant role regarding the prevalence of drainage insufficiency rather if the tube positioning was appropriate. Orv Hetil. 2019; 160(5): 172–178.

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Kingma, Berend, Onno Marges, Richard Van Hillegersberg, and Jelle Ruurda. "PS01.192: ROUTINE CHEST X-RAY AFTER REMOVAL OF CHEST TUBES IS NOT NECESSARY DURING THE POSTOPERATIVE COURSE OF ESOPHAGECTOMY." Diseases of the Esophagus 31, Supplement_1 (September 1, 2018): 104. http://dx.doi.org/10.1093/dote/doy089.ps01.192.

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Abstract Background Chest X-rays (CXRs) are commonly performed after removing chest tubes post-esophagectomy. However, literature on cardiopulmonary surgical patients suggests that a CXR might safely be reserved for patients who develop clinical respiratory signs or symptoms. Omitting unnecessary CXRs can save costs, radiation exposure, and logistic challenges, which aids the optimization of the postoperative care pathway. Therefore, the aim of this study was to investigate the clinical relevance of routinely performing a CXR after chest tube removal following esophagectomy. Methods A single-center prospectively maintained database was used to select all patients who underwent esophagectomy with gastric conduit reconstruction between 2015 and 2017. Patients who received a routine CXR 4 hours after removal of at least one chest tube or thoracic Jackson-Pratt drain were included. The radiological reports of routine CXRs were retrospectively evaluated for mentioning of intrapleural air or fluid. Cases requiring re-insertion of a chest tube on the day of routine CXR or the day afterwards were identified. Furthermore, the patients’ vital parameters were retrospectively reviewed from clinical documentation. Results Some 118 patients were included and esophagectomy was performed by a minimally invasive transthoracic (78%), an open transthoracic (14%), or a minimally invasive transhiatal (8%) approach. A total of 231 routine CXRs were performed after the removal of chest tubes (70%) and Jackson-Pratt drains (30%). Intrapleural air was found in 78 cases (34%) and was a new finding ipsilateral to previous chest tube or drain removal in 33 cases (14%). Intrapleural fluid was mentioned in 87 cases (38), which was new and ipsilateral to previous chest tube or drain removal in 24 cases (10%). Re-insertion of a chest tube was performed in 7 cases (3%). The routine CXR prior to chest tube re-insertion had shown intrapleural air (n = 3, 1%), intrapleural fluid (n = 2, 1%), or no abnormalities (n = 2, 1%). Clinical respiratory signs or symptoms (i.e. anamnestic dyspnea, an increased respiratory rate, dropping saturation levels, or need for oxygen support) occurred in all 7 patients who required chest tube re-insertion. Conclusion In conclusion, clinical respiratory signs or symptoms can safely guide the decision on whether to perform a CXR after chest tube or drain removal. Disclosure All authors have declared no conflicts of interest.

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Puntillo, KA. "Effects of interpleural bupivacaine on pleural chest tube removal pain: a randomized controlled trial." American Journal of Critical Care 5, no. 2 (March 1, 1996): 102–8. http://dx.doi.org/10.4037/ajcc1996.5.2.102.

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BACKGROUND: Moderate to severe pain associated with the removal of pleural chest tubes is poorly controlled with opioids. New methods are needed to manage the pain associated with this procedure. OBJECTIVES: To compare the effects of interpleural injections of 0.25% bupivacaine without epinephrine to those of normal saline on chest tube removal pain in cardiothoracic surgery patients. METHODS: A randomized, double-blind, placebo-controlled trial was used, with a repeated measures design. Pain intensity and distress were measured before, immediately after, and 1 hour after chest tube removal. Pain sensations and affect were evaluated immediately after chest tube removal. The experimental group (n = 21) received bupivacaine and the control group (n = 20) received normal saline. RESULTS: In both groups pain intensity and distress scores were significantly higher at the time of chest tube removal than immediately before or 1 hour after. No significant differences in pain intensity, distress, sensation, or affect scores were found between the two treatment groups. The 13 patients who received intramuscular ketorolac an average of 3.5 hours before the procedure, independent of the study design, had significantly lower pain intensity scores at the time of chest tube removal than the 26 who did not. CONCLUSIONS: These data demonstrate that chest tube removal pain is of moderate to severe intensity and that pleural chest tube injections of bupivacaine were not effective in decreasing chest tube removal pain. However, the decrease in pain associated with the administration of ketorolac warrants future study.

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Ring, Edward M. "Easier Chest Tube Insertion." Annals of Thoracic Surgery 41, no. 5 (May 1986): 583–84. http://dx.doi.org/10.1016/s0003-4975(10)63060-3.

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Davis, Lowell L. "Easier Chest Tube Insertion." Annals of Thoracic Surgery 43, no. 6 (June 1987): 688. http://dx.doi.org/10.1016/s0003-4975(10)60258-5.

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Ponn, Ronald B., Howard J. Silverman, and John A. Federico. "Outpatient Chest Tube Management." Annals of Thoracic Surgery 64, no. 5 (November 1997): 1437–40. http://dx.doi.org/10.1016/s0003-4975(97)00853-9.

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Toth, Jennifer W., Michael F. Reed, and Lauren K. Ventola. "Chest Tube Drainage Devices." Seminars in Respiratory and Critical Care Medicine 40, no. 03 (June 2019): 386–93. http://dx.doi.org/10.1055/s-0039-1694769.

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AbstractPlacement of a chest tube drains intrapleural fluid and air. The tube should be attached to a drainage system, such as one-, two-, or three-compartment devices, a one-way (Heimlich) valve for ambulatory drainage, a digital system, or a vacuum bottle. The frequently employed three-compartment systems, currently integrated disposable units, allow adjustment of negative pressure or no suction (water seal), and include an air leak meter on the water seal chamber to be used for demonstrating and quantifying air leak. These readings are subjective and prone to interobserver variability. Digital pleural drainage systems offer the benefits of quantification of any air leak and pleural pressure. Indwelling pleural catheters, typically utilized for malignant pleural effusion, can be drained using vacuum bottles. Knowledge of the design and functionality of each device in the setting of an individual patient's specific pleural process facilitates the selection of practical and financially prudent chest tube drainage strategies.

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COLIZZA, DIANE F. "actionstat Dislodged chest tube." Nursing 25, no. 9 (September 1995): 33–34. http://dx.doi.org/10.1097/00152193-199509000-00016.

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&NA;. "chest tube insertion site." Nursing 26, no. 7 (July 1996): 44–46. http://dx.doi.org/10.1097/00152193-199607000-00014.

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&NA;. "chest tube insertion site." Nursing 26, no. 7 (July 1996): 44–46. http://dx.doi.org/10.1097/00152193-199626070-00014.

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Menna, Cecilia, Mohsen Ibrahim, Camilla Poggi, Camilla Vanni, Giulio Maurizi, Antonio D’Andrilli, Anna Maria Ciccone, Federico Venuta, Erino Angelo Rendina, and Claudio Andreetti. "Outpatient chest tube management." Journal of Xiangya Medicine 3 (April 2018): 12. http://dx.doi.org/10.21037/jxym.2018.03.03.

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Gordon, Phyllis A., Joy M. Norton, and Rosa Marrell. "Refining Chest Tube Management." Dimensions Of Critical Care Nursing 14, no. 1 (January 1995): 6–16. http://dx.doi.org/10.1097/00003465-199501000-00002.

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Xu, Hao, Congying Guo, Yi Li, Lei Yang, and Linyou Zhang. "Omitting Chest Tube Drainage after Subxiphoid Thoracoscopic Thymectomy." Thoracic and Cardiovascular Surgeon 68, no. 05 (July 22, 2019): 446–49. http://dx.doi.org/10.1055/s-0039-1693027.

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Background This study investigated the feasibility and safety of omitting chest tube drainage after subxiphoid thoracoscopic thymectomy. Methods From July 2018 through October 2018, 20 patients underwent subxiphoid thoracoscopic thymectomy without chest tube drainage. The clinical characteristics and perioperative outcomes of these patients are presented. Results All patients (10 males, 10 females; average age: 53.25 ± 12.50 years old) completed the operation. Chest tube drainage was omitted in a total of 20 patients. The operative time was 89.45 ± 49.80 minutes. No adverse events were observed. The bed-side ultrasound examination of the pleural cavity on the day of surgery showed a thimbleful of effusion and did not require thoracentesis. A postoperative chest roentgenogram on the next morning showed full expansion without pneumothorax in all patients. None of the patients required reintervention with chest drainage through the time of discharge. Conclusion The omission of chest tube drainage may be an alternative procedure for selected patients undergoing thoracoscopic thymectomy. The omission of chest tubes in thymectomy is safe, but further investigation is required.

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Porntepkasemson, Apirudee, and Sarayut Lucien Geater. "Comparison of pain and efficacy between large-bore and small-bore chest tube drainage for malignant pleural effusion in Songklanagarind Hospital: A randomized controlled trial." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e19608-e19608. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e19608.

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e19608 Background: Malignant pleural effusion is one of the most common presenting symptoms in lung cancer. There has been no large RCT comparing large-bore and small-bore chest tubes in terms of pain and efficacy of management. Methods: A randomized controlled trial was conducted in 2011. Patients with malignant pleural effusion were randomly allocated to receive either a large-bore or small-bore chest tube. The primary objective was to compare pain using the Numeric Rating Scale. Other objectives included the efficacy of the drainage and pleurodesis and any complications were recorded. Results: Each arm comprised 21 patients. Median age was 61.2 years. Thirty-eight patients (90.5%) had adenocarcinoma; 14(33.3%) had received systemic chemotherapy. Pain score did not differ significantly between the groups from the time of tube insertion to removal. However, pain rose from day 4 until day 9 in the small-bore group. The proportion of patients requiring a second chest tube was higher in the small-bore group (small-bore = 7, 33.3 %; large-bore = 1, 4.8%; p 0.052). Complications were higher in the small-bore group. Five patients were complicated by tube occlusion which occurred only in the small-bore group (23.8 %, p 0.048). Times from tube insertion to lung expansion, to pleurodesis and to chest tube removal did not differ significantly between groups. Pleurodesis was effective in 70-80 % in both groups at the 28-day follow-up. Conclusions: No differences between large-bore and small-bore chest tubes were seen in pain, efficacy of drainage or success of pleurodesis. However, small-bore chest tubes had a higher rate of occlusion and more frequently required additional tube insertion.

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Lee, Yi-Ying, Po-Kuei Hsu, Chien-Sheng Huang, Yu-Chung Wu, and Han-Shui Hsu. "Complications after Chest Tube Removal and Reinterventions in Patients with Digital Drainage Systems." Journal of Clinical Medicine 8, no. 12 (December 1, 2019): 2092. http://dx.doi.org/10.3390/jcm8122092.

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Introduction: Digital thoracic drainage systems are a new technology in minimally invasive thoracic surgery. However, the criteria for chest tube removal in digital thoracic drainage systems have never been evaluated. We aim to investigate the incidence and predictive factors of complications and reinterventions after drainage tube removal in patients with a digital drainage system. Method: Patients who received lung resection surgery and had their chest drainage tubes connected with a digital drainage system were retrospectively reviewed. Results: A total of 497 patients were monitored with digital drainage systems after lung resection surgery. A total of 175 (35.2%) patients had air leak-related complications after drainage tube removals, whereas 25 patients (5.0%) required reintervention. We identified that chest drainage duration of five days was an optimal cut-off value in predicting air leak-related complications and reinterventions. In multiple logistic regression analysis, previous chest surgery history; small size (16 Fr.) drainage tubes; the presence of initial air leaks, defined as air leaks recorded by the digital drainage system immediately after operation; and duration of chest drainage ≥5 days were independent factors of air leak-related complications, whereas the presence of initial air leaks and duration of chest drainage ≥5 days were independent predictive factors of reintervention after drainage tube removal. Conclusion: Air leak-related complications and reinterventions after drainage tube removals happened in 35.2% and 5.0% of patients with digital thoracic drainage systems. The management of chest drainage tubes in patients with predictive factors, i.e., the presence of initial air leaks and duration of chest drainage of more than five days, should be treated with caution.

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Ridha, Ali, Yasir Al-Abboodi, and Matthew Fasullo. "The Outcome of Thoracentesis versus Chest Tube Placement for Hepatic Hydrothorax in Patients with Cirrhosis: A Nationwide Analysis of the National Inpatient Sample." Gastroenterology Research and Practice 2017 (2017): 1–4. http://dx.doi.org/10.1155/2017/5872068.

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There are only a few studies with a small sample size of patients that have compared the risks of using chest tubes versus thoracentesis in hepatic hydrothorax. It has been shown that many complications may arise secondary to chest tube placement and is associated with increased morbidity and mortality. In this retrospective study, patients with cirrhosis were identified from the 2009 National Inpatient Sample by using ICD-9 codes; we evaluated the risk of chest tube versus thoracentesis in a largest population with hepatic hydrothorax to date to measure the mortality and the length of stay. A total of 140,573 patients with liver cirrhosis were identified. Of this, 1981 patients had a hepatic hydrothorax and ended up with either thoracentesis (1776) or chest tube (205). The mortality in those who received a chest tube was two times higher than that in thoracentesis group with a P value of ≤0.001 (CI 1.43–312). In addition, the length of hospital stay of the chest tube group was longer than that of the thoracentesis subset (7.2 days versus 3.8 days, resp.). We concluded that chest tube placement has two times higher mortality rate and longer hospital length of stay when compared to patients who underwent thoracentesis.

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Gilbert, Timothy B., Brian J. McGrath, and Mark Soberman. "Chest Tubes: Indications, Placement, Management, and Complications." Journal of Intensive Care Medicine 8, no. 2 (March 1993): 73–86. http://dx.doi.org/10.1177/088506669300800203.

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Use of tube thoracostomy in intensive care units for evacuation of air or fluid from the pleural space has become commonplace. In addition to recognition of pathological states necessitating chest tube insertion, intensivists are frequently involved in placement, maintenance, troubleshooting, and discontinuation of chest tubes. Numerous advances have permitted safe use of tube thoracostomy for treatment of spontaneous or iatrogenic pneumothoracies and hydrothoracies following cardiothoracic surgery or trauma, or for drainage of pus, bile, or chylous effusions. We review current indications for chest tube placement, insertion techniques, and available equipment, including drainage systems. Guidelines for maintenance and discontinuation are also discussed. As with any surgical procedure, complications may arise. Appropriate training and competence in usage may reduce the incidence of complications.

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Yoshioka, Yuki, and Hisashi Ishikura. "Chest trauma management with small-bore chest tube." Journal of Emergencies, Trauma, and Shock 13, no. 4 (2020): 318. http://dx.doi.org/10.4103/jets.jets_57_20.

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Harrell, Kevin N., Dylan E. Brooks, Preston H. Palm, Jonathan T. Cowart, Robert Maxwell, and Donald Barker. "A Comparison of Prehospital Nonphysician and Hospital Physician Placed Tube Thoracostomy." American Surgeon 86, no. 7 (July 2020): 841–47. http://dx.doi.org/10.1177/0003134820940238.

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Background Prehospital chest decompression can be a lifesaving procedure in severe chest trauma. Studies investigating prehospital chest decompression are mostly European where physicians are assigned to prehospital care units. This report is one of the first to compare demographics and outcomes in patients undergoing prehospital chest decompression by trained aeromedical nonphysician personnel to hospital chest decompression by physicians. Methods Prehospital tube thoracostomy (PTT) patients were identified from January 2014 to January 2019 and were matched in a 1:2 ratio based on age, Injury Severity Score (ISS), and chest Abbreviated Injury Score (AIS) to patients who underwent hospital tube thoracostomy (HTT) within 24 hours of admission. Results Forty-nine PTT patients were matched to 98 HTT patients. PTT patients had lower admission Glasgow Coma Scale (GCS), a higher rate of pre-chest tube needle decompression, and higher level 1 trauma activation. PTT were placed sooner (21.9 vs 157.0 minutes, P < .001). Rates of tube malposition, organ injury, tube dislodgement, empyema, and hospital-acquired pneumonia over the course of hospital admission were not significantly different between the 2 groups. PTT patients had longer intensive care unit length of stay (LOS), but similar hospital LOS, and overall mortality. Discussion This report demonstrates that PTT is performed sooner than hospital placed tubes. Complication rates associated with tube thoracostomy and patient outcomes were not statistically different between PTT and HTT groups.

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Saucier, Sandra, Carrie Motyka, and Keith Killu. "Ultrasonography Versus Chest Radiography After Chest Tube Removal for the Detection of Pneumothorax." AACN Advanced Critical Care 21, no. 1 (January 1, 2010): 34–38. http://dx.doi.org/10.4037/15597768-2010-1005.

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Background Bedside ultrasound technology is an innovative, cost-effective, safe, and reproducible method used to make efficient decisions that directly affect the care of critical care patients. Purpose To validate the use of ultrasound technology when compared with the use of standard chest radiography for the detection of pneumothorax following chest tube removal. Methods A prospective observational comparison study of 50 cardiothoracic patients with surgically placed pleural chest tubes was conducted. The accuracy of bedside ultrasound technology was compared with standard chest radiography to detect pneumothorax. Results The sample κ statistic was 1.000, indicating a perfect agreement between bedside ultrasonography and chest radiography in the detection of pneumothorax. Completion of the bedside ultrasound procedure took significantly less time than chest radiography. Conclusions Bedside ultrasound technology is as accurate as chest radiography in detecting pneumothorax following chest tube removal and can save institutions’ time and money.

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Ahmed, Naveed, and Raphael Chung. "Role of Early Thoracoscopy for Management of Penetrating Wounds of the Chest." American Surgeon 76, no. 11 (November 2010): 1236–39. http://dx.doi.org/10.1177/000313481007601124.

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Most nonlife-threatening penetrating wounds of the chest (PWC) are treated with a chest tube alone. This may be inadequate because missed injuries, retained hemothorax, or foreign material may be difficult to address later. Early thoracoscopy should improve outcome. We conducted a retrospective review of 88 stable patients with PWC initially treated with a chest tube and had retained a hemothorax beyond 48 hours. Twenty-seven underwent an early video-assisted thoracoscopy (VATS). Fifty-five were observed, chest tubes were manipulated, or an additional one placed. The outcome was compared with the National Trauma Data Bank and controlled for Injury Severity Score. Early VATS reduced length of stay (4.3 vs 9.4 days), days in the intensive care unit (1.3 vs 3.2), and open thoracotomy (0 vs 7). A chest tube undertreats a nonlife-threatening PWC correctable by timely VATs.

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Sankar, V., M. Shakeel, S. Keh, and K. W. Ah-See. "A case of a ‘lost’ nasogastric tube." Journal of Laryngology & Otology 126, no. 12 (October 26, 2012): 1296–98. http://dx.doi.org/10.1017/s0022215112002447.

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AbstractObjectives:To present the case of a ‘lost’ nasogastric tube and to highlight the importance of imaging and/or chest X-ray after nasogastric tube insertion, especially in unreliable patients.Case report:A 50-year-old man, undergoing radiotherapy treatment for squamous cell carcinoma of the tongue base, was admitted for pain control and nasogastric tube feeding. This patient required multiple nasogastric tubes over a two-week period. The patient repeatedly denied pulling the nasogastric tube out and we were unable to establish the exact mode of nasogastric tube removal. On one such occasion another tube was inserted and a check X-ray showed two feeding tubes; the latest one was lying in the left main bronchus and the old nasogastric tube was observed in the oesophagus, with its upper end jutting above the hypopharynx. It was apparent that the patient had somehow cut the tube and swallowed it.Conclusion:This case not only illustrates the importance of flexible nasendoscopy and/or chest X-ray for checking the position of the nasogastric tube, but also highlights that some patients are not tolerant of nasogastric tubes. The use of nasogastric tubes should be avoided in these patients to prevent any self-inflicted injury.

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Ramanathan, Rajesh, Luke G. Wolfe, and Therese M. Duane. "Initial Suction Evacuation of Traumatic Hemothoraces: A Novel Approach to Decreasing Chest Tube Duration and Complications." American Surgeon 78, no. 8 (August 2012): 883–87. http://dx.doi.org/10.1177/000313481207800824.

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Between 2 and 4.4 per cent of all patients with trauma chest tubes develop retained hemothoraces. Retained hemothoraces prolong chest tube duration and hospital length of stay, and increase infectious complications like empyema. Early surgical drainage of retained hemothoraces has been shown to decrease complications and reduce hospital length of stay. However, the high resource and expertise requirement may limit the widespread applicability of surgical drainage. We present the results of a relatively simple and novel intervention for traumatic hemothoraces undertaken by our faculty to shorten chest tube duration and prevent empyema formation. At our Level I trauma center, 10 trauma patients underwent initial suction evacuation of their traumatic hemothoraces using a sterile suction catheter before chest tube placement. Compared with propensity matched controls, patients that underwent initial suction evacuation experienced significantly shorter chest tube duration (4.2 ± 1.9 vs 5.8 ± 2.3 days, P = 0.04). Also, in this population, there was an 8.2 per cent decrease in the number of patients that developed empyema or required additional drainage. Our study suggests that initial suction evacuation of traumatic hemothoraces is an effective and relatively easy intervention that reduces the duration of chest tube therapy, empyema formation, and the need for additional surgical intervention.

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Goodwin, R. A., M. Reaume, V. Gallant, G. MacArtney, D. Maziak, F. Matzinger, and S. Gertler. "Efficacy and compliance of small-bore chest tube insertion and pleurodesis protocols for the treatment of malignant pleural effusions." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 19575. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.19575.

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19575 Background: Small-bore chest tubes are now recognized as a safe and effective alternative to large-bore catheter chest tubes for the treatment of malignant pleural effusions (MPEs). The Ottawa Hospital (TOH) developed protocols for insertion and pleurodesis to maximize efficiency and minimize complications. Objective: To evaluate the efficacy and compliance of small-bore chest tube insertion and pleurodesis protocols for the treatment of MPEs. Methods: Retrospective chart review of TOH medical oncology inpatients treated for a MPE using our small-bore chest tube insertion and pleurodesis protocols from February 2003 to May 2004. Outcomes reviewed included deviations from protocol (major and minor), proportion of patients proceeding to pleurodesis and efficacy at six weeks, complications, as well as length of hospital stay. Results: One-hundred and fourteen potential cases were identified, of those 78 small-bore chest tubes were inserted into 72 patients. Major deviations from the chest tube protocol occurred in 21 patients (27%) who lacked microbiological analysis of their pleural fluid. Major complications of tube insertion occurred in ten patients (13%) who developed pulmonary infections and two patients (2.5%) who developed a significant pneumothorax. Of the 78 tube insertions, 24 cases went on to pleurodesis. Major deviations from our pleurodesis protocol occurred in five patients (2.1%) who failed to have a chest xray twenty-four hours prior to pleurodesis. The most common complication post pleurodesis was pain with seven of 24 patients (29%) rating their pain as severe. Fifteen of the 24 patients (63%) had fluid reaccumulation within six-weeks post pleurodesis. Median length of stay for patients without pleurodesis versus those with pleurodesis was 14.5 and 16.0 days, respectively. Conclusions: Our preliminary data suggests that chest tube insertion and pleurodesis protocols have good compliance rates with low rates of complications. Only a minority of patients were able to proceed to pleurodesis and long term control of effusion occurs in less than half of patients in this subgroup. As well, pain control at the time of pleurodesis was not adequate in one third of patients with the current protocol. No significant financial relationships to disclose.

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Almeida, Raquel Constantino de, Priscilla Alfradique de Souza, Rosimere Ferreira Santana, and Aline Affonso Luna. "Nursing intervention: post-operative care with chest tube in adults." Revista da Rede de Enfermagem do Nordeste 19 (August 16, 2018): e3332. http://dx.doi.org/10.15253/2175-6783.2018193332.

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Kim, Kyung Soo. "Technique for chest tube removal." ASVIDE 4 (May 2017): 226. http://dx.doi.org/10.21037/asvide.2017.226.

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Takahashi, Yusuke, Osamu Mishima, Morihisa Kitano, Kenji Misawa, and Toshiki Ushiyama. "Method for chest tube removal." Journal of the Japanese Association for Chest Surgery 27, no. 4 (2013): 435–39. http://dx.doi.org/10.2995/jacsurg.27.435.

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Punyadasa, Amila C. A. C. Y., and Augustine Tee. "‘Pseudopneumothorax’—Hold that chest tube!" International Journal of Emergency Medicine 1, no. 1 (March 15, 2008): 59–60. http://dx.doi.org/10.1007/s12245-008-0007-5.

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Sharma, D., and F. siddiqui. "CHEST TUBE IN LUNG PARENCHYMA." Chest 155, no. 4 (April 2019): 269A. http://dx.doi.org/10.1016/j.chest.2019.02.385.

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Quigley, Robert L. "Thoracentesis and Chest Tube Drainage." Critical Care Clinics 11, no. 1 (January 1995): 111–26. http://dx.doi.org/10.1016/s0749-0704(18)30088-5.

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KOHLMAN, PHYLLIS ANN. "MANAGING A Draining Chest Tube." Nursing 18, no. 8 (August 1988): 58–59. http://dx.doi.org/10.1097/00152193-198808000-00019.

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