HWN Suggests

Trocar during Times of Trauma

Chest tube insertion should be well-rehearsed and instinctive. You should not hesitate to insert a life-saving tube into a pleural cavity immediately to drain air, blood, bile, or pus. Obtaining a thorough history and chest x-ray is absolutely pivotal to your diagnosis. Know your landmarks before insertion: the fourth and fifth intercostal space and the anterior-axial line. Go up and over the rib as you insert chest tubes. Avoid the lower rib margin to prevent injury to the neurovascular bundle.

You can use one of several tube thoracostomy techniques. Most clinicians prefer standard or classic insertion, that is, blunt dissection (incision, Kelly clamp, finger placement, tube placement).…

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 Back to Basics: Chest Tube Insertion

Full disclosure, these are tips and tricks I learned by trial and error and through word of mouth, and they have not been formally studied or peer reviewed.

 Bougie-assisted intercostal catheter insertion

Bougies can be used as a rescue technique for intercostal catheter insertion when the standard approach is problematic (e.g. in an obese patient where it is easy to lose the tract when inserting the intercostal catheter)

 Chest drains & aspiration: Do it better with St.Emlyn’s

This is just a quickie to support some local teaching in Virchester on ‘chest drain’ insertion, or ‘intercostal drains’ if you prefer additional consonants or ‘chest tubes’ if you are from the land of the Trump. Anyway chest drains are one of those procedures that are rare enough that we need to think about, but common enough that we really should be expert in.

 Own the Chest Tube!

This time round, we’re going to ‘own the chest tube!’ — as well as the chest drain and a few other things along the way…

 Tube Thoracostomy

Insertion site should be in the ANTERIOR axillary line at the 4-5th intercostal space

 Tube Thoracostomy (Chest Tubes) Part 1 Peri-procedural Chest Tube Stuff

Chest tubes were once a bedrock procedure for EM, Resuscitation, and Critical Care. They are now not quite dinosaurs, but they are becoming increasingly unnecessary.

Articles of Interest

Procedure Series: Chest Tube Thoracostomy

A chest tube is placed in the lateral chest wall in an area called the “triangle of safety,” which is made of the borders of pectoralis major, the nipple line (5th intercostal space), and latissimus dorsi.

REBEL Core Cast 34.0 – Chest Tubes

Small to Moderate Size Pneumothorax – consider managing conservatively with observation (need to make sure consulting services on same page).

Small-bore chest tubes seem to perform better than larger tubes in treatment of spontaneous pneumothorax

Compared with patients treated with smaller chest tubes, patients with surgical large-bore tubes had more complications (27.4% versus 9.5%; p = 0.026), a lower success rate (56.5% versus 85.7%; p = 0.002), and longer duration of chest tube (8.3 versus 4.9 days; p = 0.001) and of hospitalisation (11.8 versus 6.9 days; p = 0.004).

Unlocking Common ED Procedures – Cutting Through the Triangle: A Review of Tube Thoracostomy in the ED

Placement of a thoracostomy tube, more frequently referred to as a chest tube in the ED, is one of the most common invasive surgical procedures performed by emergency physicians. While this classic procedure has undergone several stages of evolution over the years, its principle is still centered around the placement of a tube or catheter within the pleural cavity with the intent of draining either air or fluid that has collected within the intrapleural space.

What’s the Best Intervention for Primary Spontaneous Pneumothorax?

The management of an otherwise stable but symptomatic patient with PSP typically boils down to a few key decisions. First, is any intervention required? Secondly, if so, what sort of invention: standard chest tube, narrow-bore chest tube, or aspiration? Finally, should a patient be discharged home or remain in the hospital for observation?