Introduction: Tube thoracostomy is an invasive procedure, which may result in life-threatening injury to major organs and blood vessels. We propose a new approach for inserting tube thoracostomies to improve the safet...Introduction: Tube thoracostomy is an invasive procedure, which may result in life-threatening injury to major organs and blood vessels. We propose a new approach for inserting tube thoracostomies to improve the safety of this procedure, termed guided blunt dissection. In this article, we compared the safety of this new approach with traditional blunt dissection and two commercially available Seldinger tube thoracostomy kits in an ex vivo model. Methods: We recruited 32 clinicians from a variety of medical specialties with a range of experience in performing tube thoracostomy. Each clinician was required to perform tube thoracostomy using all four approaches in a randomised order. Objectively, each insertion was categorised as “safe” if the lung remained intact and “unsafe” if the lung deflated. Subjectively, participants were asked to rank each approach in order of perceived safety on a four-point scale. Statistical analysis was performed using a Fisher’s exact test. Results: Objectively, guided blunt dissection was significantly safer than both Seldinger approaches (p 0.0001), but not traditional blunt dissection (p = 0.71). Subjectively, none of the approaches were felt to be superior. Conclusions: These data support the conclusions that, in this ex vivo model, the new guided blunt dissection approach provided a safe method for tube thoracostomy. Guided blunt dissection produced less lung deflations relative to competing methods, certainly when compared objectively to Seldinger techniques. Of note, the Seldinger approaches were perceived by the participants to be as safe despite there being an increased incidence of lung injury associated with their use in this model. This indicates that it was not always possible for the clinician to determine when lung injury had occurred. This potential for lung injury when using Seldinger approaches for tube thoracostomy should be emphasised.展开更多
BACKGROUND: Thoracostomy tube insertion is one of the common bedside procedures in emergency medicine and many acute specialties. Dislodgement of thoracostomy tube from the connection tube of chest drainage system is ...BACKGROUND: Thoracostomy tube insertion is one of the common bedside procedures in emergency medicine and many acute specialties. Dislodgement of thoracostomy tube from the connection tube of chest drainage system is an important problem with potential complications such as contamination, infection and pneumothorax. Besides, mere loosening can also lead to malfunction. It is a common practice to tape the connection of the system. This study aimed to evaluate the materials and methods of connection of chest drain system to minimize drainage dislodgement. METHODS: We conducted an experimental study to assess the tightness of the connection with various taping materials and methods. We selected three commonly used adhesive materials(3M^(tm) Transpore^(tm) Medical tape, 3M^(tm) Micropore^(tm) Medical tape, 3M^(tm) Soft Cloth Tape on Liner) and three different methods(cross method, straight method, nylon band) to secure the junction between the thoracostomy tube and the bi-conical adaptor in the drainage system. The measured outcome was the weight causing visible loosening of the junction between thoracotomy tube and the adaptor.RESULTS: For each taping material and taping method, 10 trials were performed. The median weight required to disconnect the junction is 26.22 lb for Transpore^(tm), 31.29 lb for Micropore^(tm) and 32.44 lb for Soft Cloth Tape on Liner. A smaller force was required to disconnect if Transpore^(tm) is used(P<0.001). There was no statistical signifi cant difference between Micropore^(tm) and Soft Cloth Tape on Liner(P=0.98). The median disconnecting force is 32.44 lb for straight taping method, 40.55 lb for cross taping method and 21.15 lb for plastic band. The cross-taping method was the more secure method(P<0.0001 when compared with plastic band)(P=0.033 when compared with straight method).CONCLUSION: Cross-taping is the most secure method among the tested varieties in connecting the thoracostomy tube to the chest drainage system. Transpore^(tm) is not a recommended material for thoracostomy tube taping.展开更多
BACKGROUND Trauma is the leading cause of death in young adults up to the age of 45 years.Hemothorax is a frequent consequence of penetrating thoracic trauma,and is usually associated with pneumothorax and pneumoderma...BACKGROUND Trauma is the leading cause of death in young adults up to the age of 45 years.Hemothorax is a frequent consequence of penetrating thoracic trauma,and is usually associated with pneumothorax and pneumoderma.Intercostal arterial bleeding or intrathoracic hemorrhage occurs after penetrating thoracic trauma,and uncontrolled bleeding is the main cause of death.CASE SUMMARY In this case report,a patient who developed a right hemopneumothorax after penetrating thoracic trauma was examined.A 19-year-old male patient,who was brought to the emergency room with a penetrating stab injury to the posterior of the left hemithorax,was diagnosed with a right hemopneumothorax after physical examination and thoracic imaging.Chest tube thoracostomy was performed as the initial intervention.Bleeding control was achieved with right posterolateral thoracotomy in the patient,who developed massive hemorrhage after 1 h and hemodynamic instability.The patient recovered and was discharged on the fourth postoperative day.CONCLUSION Contralateral hemopneumothorax that accounts for 30%of thoracic traumas and can be encountered in penetrating thoracic traumas requiring major surgery in 15-30%of cases was emphasized and the contralateral development mechanism was addressed.展开更多
文摘Introduction: Tube thoracostomy is an invasive procedure, which may result in life-threatening injury to major organs and blood vessels. We propose a new approach for inserting tube thoracostomies to improve the safety of this procedure, termed guided blunt dissection. In this article, we compared the safety of this new approach with traditional blunt dissection and two commercially available Seldinger tube thoracostomy kits in an ex vivo model. Methods: We recruited 32 clinicians from a variety of medical specialties with a range of experience in performing tube thoracostomy. Each clinician was required to perform tube thoracostomy using all four approaches in a randomised order. Objectively, each insertion was categorised as “safe” if the lung remained intact and “unsafe” if the lung deflated. Subjectively, participants were asked to rank each approach in order of perceived safety on a four-point scale. Statistical analysis was performed using a Fisher’s exact test. Results: Objectively, guided blunt dissection was significantly safer than both Seldinger approaches (p 0.0001), but not traditional blunt dissection (p = 0.71). Subjectively, none of the approaches were felt to be superior. Conclusions: These data support the conclusions that, in this ex vivo model, the new guided blunt dissection approach provided a safe method for tube thoracostomy. Guided blunt dissection produced less lung deflations relative to competing methods, certainly when compared objectively to Seldinger techniques. Of note, the Seldinger approaches were perceived by the participants to be as safe despite there being an increased incidence of lung injury associated with their use in this model. This indicates that it was not always possible for the clinician to determine when lung injury had occurred. This potential for lung injury when using Seldinger approaches for tube thoracostomy should be emphasised.
文摘BACKGROUND: Thoracostomy tube insertion is one of the common bedside procedures in emergency medicine and many acute specialties. Dislodgement of thoracostomy tube from the connection tube of chest drainage system is an important problem with potential complications such as contamination, infection and pneumothorax. Besides, mere loosening can also lead to malfunction. It is a common practice to tape the connection of the system. This study aimed to evaluate the materials and methods of connection of chest drain system to minimize drainage dislodgement. METHODS: We conducted an experimental study to assess the tightness of the connection with various taping materials and methods. We selected three commonly used adhesive materials(3M^(tm) Transpore^(tm) Medical tape, 3M^(tm) Micropore^(tm) Medical tape, 3M^(tm) Soft Cloth Tape on Liner) and three different methods(cross method, straight method, nylon band) to secure the junction between the thoracostomy tube and the bi-conical adaptor in the drainage system. The measured outcome was the weight causing visible loosening of the junction between thoracotomy tube and the adaptor.RESULTS: For each taping material and taping method, 10 trials were performed. The median weight required to disconnect the junction is 26.22 lb for Transpore^(tm), 31.29 lb for Micropore^(tm) and 32.44 lb for Soft Cloth Tape on Liner. A smaller force was required to disconnect if Transpore^(tm) is used(P<0.001). There was no statistical signifi cant difference between Micropore^(tm) and Soft Cloth Tape on Liner(P=0.98). The median disconnecting force is 32.44 lb for straight taping method, 40.55 lb for cross taping method and 21.15 lb for plastic band. The cross-taping method was the more secure method(P<0.0001 when compared with plastic band)(P=0.033 when compared with straight method).CONCLUSION: Cross-taping is the most secure method among the tested varieties in connecting the thoracostomy tube to the chest drainage system. Transpore^(tm) is not a recommended material for thoracostomy tube taping.
文摘BACKGROUND Trauma is the leading cause of death in young adults up to the age of 45 years.Hemothorax is a frequent consequence of penetrating thoracic trauma,and is usually associated with pneumothorax and pneumoderma.Intercostal arterial bleeding or intrathoracic hemorrhage occurs after penetrating thoracic trauma,and uncontrolled bleeding is the main cause of death.CASE SUMMARY In this case report,a patient who developed a right hemopneumothorax after penetrating thoracic trauma was examined.A 19-year-old male patient,who was brought to the emergency room with a penetrating stab injury to the posterior of the left hemithorax,was diagnosed with a right hemopneumothorax after physical examination and thoracic imaging.Chest tube thoracostomy was performed as the initial intervention.Bleeding control was achieved with right posterolateral thoracotomy in the patient,who developed massive hemorrhage after 1 h and hemodynamic instability.The patient recovered and was discharged on the fourth postoperative day.CONCLUSION Contralateral hemopneumothorax that accounts for 30%of thoracic traumas and can be encountered in penetrating thoracic traumas requiring major surgery in 15-30%of cases was emphasized and the contralateral development mechanism was addressed.
