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Roebker JA, Kord A, Chan K, Rao R, Ray CE, Ristagno R. Chest Tube Placement and Management: A Practical Review. Semin Intervent Radiol 2023; 40:231-239. [PMID: 37333751 PMCID: PMC10275667 DOI: 10.1055/s-0043-1768680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Affiliation(s)
- James A. Roebker
- Division of Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Ali Kord
- Division of Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Kaelan Chan
- Division of Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Rahul Rao
- Division of Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Charles E. Ray
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
| | - Ross Ristagno
- Division of Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
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2
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Kushida Y, Takeuchi I, Muramatsu KI, Nagasawa H, Jitsuiki K, Ohsaka H, Ishikawa K, Yanagawa Y. A Comparison of Tube Thoracostomy for Chest Trauma Between Prehospital and Inhospital Settings. Air Med J 2023; 42:24-27. [PMID: 36710031 DOI: 10.1016/j.amj.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/19/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We compared the outcomes of patients with tube thoracostomy for chest trauma between the prehospital and inhospital settings. METHODS The subjects were then divided into 2 groups: the prehospital group, which included subjects who underwent tube thoracostomy in the prehospital setting, and the inhospital group, which included subjects who underwent tube thoracostomy in the inhospital setting. The variables were compared between the 2 groups. RESULTS There were no significant differences between the 2 groups with regard to gender, age, history, mechanism of injury, infusion of antibiotics, white blood cell count, duration of insertion of a chest drain, mechanical ventilation, complication of drain infection, duration of admission, or final outcome. However, the Injury Severity Score, maximum C-reactive protein level, and maximum temperature during hospitalization in the prehospital group (n = 15) were significantly greater than those in the inhospital group (n = 119). CONCLUSION The present study suggested that thoracostomy performed by physicians in the prehospital setting was safe and did not have an increased risk of infection. In addition, thoracostomy for chest injury in the prehospital setting suggested an improvement in the likelihood of a survival outcome.
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Affiliation(s)
- Yoshihiro Kushida
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka, Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka, Japan
| | - Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka, Japan
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka, Japan
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka, Japan
| | - Kouhei Ishikawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka, Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni City, Shizuoka, Japan.
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Khurana N, Salei A, Gunn AJ, Huang J. Antibiotics Tubes and Lines. Semin Intervent Radiol 2022; 39:421-427. [PMID: 36406021 PMCID: PMC9671683 DOI: 10.1055/s-0042-1758080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Antibiotic prophylaxis in interventional radiology (IR) is widely used; however, such practice is based on data from the surgical literature. Although published guidelines can help determine the need for prophylactic antibiotic use in the patient undergoing percutaneous procedures, local practice patterns often dictate when such medications are given. In this article, the current state of periprocedural antibiotic use in commonly performed IR procedures (i.e., tube and catheter placements) is presented.
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Affiliation(s)
- Navpreet Khurana
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aliaksei Salei
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew J. Gunn
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Junjian Huang
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
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4
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Ukeh I, Fang A, Patel S, Opoku K, Nezami N. Percutaneous Chest Tube for Pleural Effusion and Pneumothorax. Semin Intervent Radiol 2022; 39:234-247. [PMID: 36062227 PMCID: PMC9433150 DOI: 10.1055/s-0042-1751295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Chest tubes are placed in the pleural space to evacuate abnormal fluid or air accumulations. Various types and sizes of chest tubes are available. Imaging including ultrasound, computed tomography, and fluoroscopy should be used to guide chest tube placement. Understanding the anatomy of the pleural space, along with the etiology and classification of pleural space disease, can help optimize chest tube management. This article will review the indications, contraindications, techniques, and postprocedure follow-up of chest tube placement as well as discuss the management and prevention of complications.
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Affiliation(s)
- Ifechi Ukeh
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Adam Fang
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sandhya Patel
- Naval Medical Center, Aviation Medicine, San Diego, California
| | - Kwaku Opoku
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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5
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Impact of routine chest radiographs after removal of pigtail chest tubes placed by pediatric interventional radiology. Pediatr Radiol 2022; 52:971-976. [PMID: 35076728 DOI: 10.1007/s00247-021-05265-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/17/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Chest radiographs are commonly obtained after chest tube removal to assess for complications. The benefit of this practice in children is uncertain. OBJECTIVE To determine the clinical impact of a routine chest radiograph following removal of chest tubes placed by pediatric interventional radiology. MATERIALS AND METHODS This single-center retrospective study evaluated 200 chest tube removals in 176 patients (median age: 4 years, interquartile range [IQR]: 1.2-12; median weight: 17.2 kg, IQR: 10.67-37.6), who had a chest tube placed and removed by pediatric interventional radiology over a 16-year period. A chest radiograph obtained on the day of removal was compared to the preceding study. For patients with imaging changes, medical records were reviewed to determine whether clinical actions occurred as a result. All records were reviewed for 7 days after tube removal or hospital discharge, whichever occurred first. RESULTS The most common indication for chest tube insertion was simple effusion (53%, 106/200) and the most common tube size was 10.2 French (38.7%, 81/209). The median tube dwell time was 8 days (IQR: 5-17). There was a median of 14 h (IQR: 7-33.5) between imaging before and after tube removal. Imaging changes occurred in 10% (n = 20/200) of chest tube removals. Three of 200 (1.5%) of these were symptomatic after removal and only 0.5% (1/200) required chest tube reinsertion. For the remaining removals resulting in chest radiograph changes, patients were asymptomatic and required no change in clinical management. CONCLUSION For chest tubes placed by pediatric interventional radiology, these findings do not support the practice of a routine chest radiograph after removal in asymptomatic children.
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Adil O, Russell JL, Khan WU, Amaral JG, Parra DA, Temple MJ, Muthusami P, Connolly BL. Image-guided chest tube drainage in the management of chylothorax post cardiac surgery in children: a single-center case series. Pediatr Radiol 2021; 51:822-830. [PMID: 33515053 DOI: 10.1007/s00247-020-04928-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/23/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND In children, chylothorax post cardiac surgery can be difficult to treat, may run a protracted course, and remains a source of morbidity and mortality. OBJECTIVE To analyze the experience with percutaneous image-guided chest-tube drainage in the management of post-cardiac-surgery chylothoraces in children. MATERIALS AND METHODS We conducted a single-center retrospective case series of 37 post-cardiac-surgery chylothoraces in 34 children (20 boys; 59%), requiring 48 drainage procedures with placement of 53 image-guided chest tubes over the time period 2004 to 2015. We analyzed clinical and procedural details, adverse events and outcomes. Median age was 0.6 years, median weight 7.2 kg. RESULTS Attempted treatments of chylothoraces prior to image-guided chest tubes included dietary restrictions (32/37, 86%), octreotide (12/37, 32%), steroids (7/37, 19%) and thoracic duct ligation (5/37, 14%). Image-guided chest tubes (n=43/53, 81%) were single unilateral in 29 children, bilateral in 4 (n=8/53, 15%), and there were two ipsilateral tubes in one (2/53, 4%). Effusions were isolated, walled-off, in 33/53 (62%). In 20/48 procedures (42%) effusions were septated/complex. The mean drainage through image-guided chest tubes was 17.3 mL/kg in the first 24 h, and 13.4 mL/kg/day from diagnosis to chest tube removal; total mean drainage from all chest tubes was 19.6 mL/kg/day. Nine major and 27 minor maintenance procedures were required during 1,207 tube-days (rate: 30 maintenance/1,000 tube-days). Median tube dwell time was 21 days (range 4-57 days). There were eight mild adverse events, three moderate adverse events and no severe adverse events related to image-guided chest tubes. Radiologic resolution was achieved in 26/37 (70%). Twenty-three children (68%) survived to discharge; 11 children (32%) died from underlying cardiac disease. CONCLUSION Management of chylothorax post-cardiac-surgery in children is multidisciplinary, requiring concomitant multipronged approaches, often through a protracted course. Multiple image-guided chest tube drainages can help achieve resolution with few complications. Interventional radiology involvement in tube care and maintenance is required. Overall, mortality remains high.
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Affiliation(s)
- Omar Adil
- Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Jennifer L Russell
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Waqas U Khan
- Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Joao G Amaral
- Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Dimitri A Parra
- Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Michael J Temple
- Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Prakash Muthusami
- Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,Neuroradiology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Bairbre L Connolly
- Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada. .,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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Botwin AL, Niedzwiecki GA, Botwin KP. Persistent air leak treated by autologous blood patch pleurodesis: the role of CT-guided small-bore chest tube insertion. Clin Imaging 2020; 60:75-78. [DOI: 10.1016/j.clinimag.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/28/2019] [Accepted: 12/02/2019] [Indexed: 11/24/2022]
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8
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Broder JS, Al-Jarani B, Lanan B, Brooks K. Pigtail Catheter Insertion Error: Root Cause Analysis and Recommendations for Patient Safety. J Emerg Med 2020; 58:464-472. [PMID: 31926779 DOI: 10.1016/j.jemermed.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/25/2019] [Accepted: 10/13/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Small-caliber chest tubes are used to treat pneumothorax and pleural fluid collections. Although commonly considered a less invasive alternative to large-caliber thoracostomy tubes, small-caliber tubes have a high complication rate. Emergency physicians must be familiar with common and dangerous procedure complications associated with these devices and have a systematic and rapid approach to identify and solve malfunctions. Structured root cause analysis can facilitate identification of problems. METHODS We reviewed the medical literature for complications of small-caliber chest tubes and searched the U.S. Food and Drug Administration (FDA) database for complications of a specific pigtail catheter kit. Using a structured root cause analysis (RCA), we examined two cases of retained pigtail catheter obturators resulting in catheter malfunction and unresolved pneumothorax. RESULTS We identified common complications of pigtail catheters from the medical literature, as well as 28 reports to FDA of complications with the kit used in the analyzed cases; ours were the only reports of the obturator error. RCA identified multiple contributing factors, including unrecognized and novel radiographic clues, human errors, communication breakdown, device design, and opportunities for improved systematic procedural approach. DISCUSSION We discuss factors identified in RCA and regulatory considerations relevant to emergency physicians, including FDA reporting mechanisms. CONCLUSIONS A structured review of complications of pigtail catheter insertion revealed opportunities for improved patient safety. We highlight a preventable error in insertion of a percutaneous catheter and describe radiographic features to enhance error detection. Improved design, systematic processes for device insertion and troubleshooting, and enhanced provider education could reduce the risk of medical device errors. An end-of-procedure time-out including instrument counts and systematic assessment of device function is a generalizable patient safety measure for bedside procedures.
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Affiliation(s)
- Joshua S Broder
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Bahaadin Al-Jarani
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Brenda Lanan
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Kelli Brooks
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina
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Santos EDCD, Silva JDSD, Assis Filho MTTD, Vidal MB, Lunardi AC. Use of lung expansion techniques on drained and non-drained pleural effusion: survey with 232 physiotherapists. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.33.ao05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Techniques for lung expansion seem to benefit patients with drained and undrained pleural effusion, but there is a lack of evidence to indicate which technique is best in each situation. Currently, the therapeutic choices of respiratory physiotherapists serving this population are not known. Objective: To know which lung expansion techniques are chosen by chest physiotherapists who assist patients with drained and non-drained pleural effusion. Method: Through the announcement of the Federal Council, 232 physiotherapists who work in hospitals in Brazil were questioned about which techniques they apply to patients with drained and non-drained effusion. Results: Initially, 512 were questioned but 232 (45.3%) answered. The physiotherapists associate more than one technique of lung expansion in both types of patients, besides walking. Deep breathing is the most used technique in patients with drained (92%) and non-drained (77%) pleural effusion. Positive pressure exercises in the airways are chosen by 60% of the physiotherapists to treat patients with drained pleural effusion and by 34% to treat patients with non-drained pleural effusion. Yet the incentive spirometry are used with 66% of patients with drained pleural effusion and 42% with non-drained ones. Conclusion: Deep breathing is the most applied lung expansion technique in the treatment of patients with drained and non-drained pleural effusion by chest physiotherapists. In addition, there is association between greatest degree and time of professional performance and the chosen techniques.
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10
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Heraganahally S, Mehra S, Veitch D, Sajkov D, Falhammar H, Morton S. New cost-effective pleural procedure training: manikin-based model to increase the confidence and competency in trainee medical officers. Postgrad Med J 2019; 95:245-250. [PMID: 30992415 DOI: 10.1136/postgradmedj-2018-136380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 01/21/2019] [Accepted: 03/16/2019] [Indexed: 11/04/2022]
Abstract
PURPOSE OF THE STUDY Pleural diseases are common in clinical practice. Doctors in training often encounter these patients and are expected to perform diagnostic and therapeutic pleural procedures with confidence and safely. However, pleural procedures can be associated with significant complications, especially when performed by less experienced. Structured training such as use of training manikin and procedural skills workshop may help trainee doctors to achieve competence. However, high costs involved in acquiring simulation technology or attending a workshop may be a hurdle. We hereby describe a training model using a simple manikin developed in our institution and provide an effective way to document skill acquisition and assessment among trainee medical officers. STUDY DESIGN This was a prospective observational study. The need for training, competence and confidence of trainees in performing pleural procedures was assessed through an online survey. Trainees underwent structured simulation training through a simple manikin developed at our institute. Follow-up survey after the training was then performed to access confidence and competence in performing pleural procedures. RESULTS Forty-seven trainees responded to an online survey and 91% of those expressed that they would like further training in pleural procedure skills. 81% and 85% of responders, respectively, indicated preferred method of training is either practising on manikin or performing the procedure under supervision. Follow-up survey showed improvement in the confidence and competence. CONCLUSION Our pleural procedure training manikin model is a reliable, novel and cost-effective method for acquiring competences in pleural procedures.
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Affiliation(s)
- Subash Heraganahally
- Respiratory and Sleep Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia .,Respiratory and Sleep Medicine, Royal Darwin Hospital, Casuarina, Northern Territory, Australia
| | - Sumit Mehra
- Respiratory and Sleep Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Daisy Veitch
- SHARP Dummies Pty Ltd, Adelaide, South Australia, Australia.,Industrial Design Engineering, Delft University of Technology, TU Delft, The Netherlands
| | - Dimitar Sajkov
- Respiratory and Sleep Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Medicine, Royal Darwin Hospital, Casuarina, Northern Territory, Australia
| | - Sharon Morton
- Respiratory and Sleep Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
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Barker DA, Trinterud T, Demetriou JL. Fluoroscopically guided wide-bore thoracostomy tube placement: Description of the technique and comparison to blind placement. Vet Surg 2018; 47:1046-1051. [PMID: 30302761 DOI: 10.1111/vsu.13106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 03/05/2018] [Accepted: 04/03/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe and compare fluoroscopic guidance for placement of wide-bore thoracostomy tubes (FGTT) to traditional, blind placement of thoracostomy tubes (BPTT). STUDY DESIGN Prospective clinical trial. ANIMALS Twenty client-owned dogs. METHODS Dogs requiring medical management of pleural effusion received a BPTT, whereas dogs undergoing postoperative management of pneumothorax and/or pleural fluid after lateral thoracotomy received an FGTT. Time of placement, accuracy of positioning, radiation exposure, and complications were compared between groups. RESULTS Initial placement of BPTT took a mean of 168 seconds (range, 89-197), whereas adequate placement was radiographically confirmed at 20 minutes and 38 seconds (range, 7 minutes and 57 seconds to 39 min). Initial placement of FGTT took a mean time of 108 seconds (range, 50-341, P = .17), and adequate placement was confirmed at 125 seconds (range, 50-341, P < .001). Major errors in placement requiring removal and replacement occurred in 2 dogs for BPTT and in none for FGTT. Procedural complications did not differ between groups, and no postoperative complication occurred within the first 12 hours after placement. Radiation entrance surface dose was lower in the BPTT group (P = .004), but stochastic radiation doses did not differ. CONCLUSION Fluoroscopic guidance of wide-bore thoracostomy tubes accelerated the time to accurate tube placement and alleviated the requirement for removal and replacement in this population. Although use of fluoroscopy increased radiation entrance surface dose, the dose was not clinically significant. CLINICAL SIGNIFICANCE Fluoroscopic guidance of wide-bore thoracostomy tubes should be considered as an alternative to traditional, blind placement.
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Affiliation(s)
- David A Barker
- Dick White Referrals, Six Mile Bottom, Newmarket, United Kingdom
| | - Tonje Trinterud
- Dick White Referrals, Six Mile Bottom, Newmarket, United Kingdom
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12
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MANEJO DE LAS PLEUROSTOMÍAS. REVISTA MÉDICA CLÍNICA LAS CONDES 2018. [DOI: 10.1016/j.rmclc.2017.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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13
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Lewis MR, Micic TA, Doull IJM, Evans A. Real-time ultrasound-guided pigtail catheter chest drain for complicated parapneumonic effusion and empyema in children - 16-year, single-centre experience of radiologically placed drains. Pediatr Radiol 2018; 48:1410-1416. [PMID: 29951836 PMCID: PMC6105150 DOI: 10.1007/s00247-018-4171-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/29/2018] [Accepted: 04/12/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chest tube drainage with fibrinolytics is a cost-effective treatment option for parapneumonic effusion and empyema in children. Although the additional use of ultrasound (US) guidance is recommended, this is rarely performed in real time to direct drain insertion. OBJECTIVE To evaluate the effectiveness and safety of real-time US-guided, radiologically placed chest drains at a tertiary university hospital. MATERIALS AND METHODS This was a retrospective review over a 16-year period of all children with parapneumonic effusion or empyema undergoing percutaneous US-guided drainage at our centre. RESULTS Three hundred and three drains were placed in 285 patients. Treatment was successful in 93% of patients after a single drain (98.2% success with 2 or 3 drains). Five children had peri-insertion complications, but none was significant. The success rate improved with experience. Although five patients required surgical intervention, all children treated since 2012 were successfully treated with single-tube drainage only and none has required surgery. CONCLUSION Our technique for inserting small-bore (≤8.5 F) catheter drains under US guidance is effective and appears to be a safe procedure for first-line management of complicated parapneumonic effusion and empyema.
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Affiliation(s)
- Megan R. Lewis
- Department of Postgraduate Medical and Dental Education at Cardiff University, Heath Park Way, Cardiff, UK CF14 4YU
| | - Thomas A. Micic
- Department of Paediatric Radiology, Children’s Hospital for Wales, Heath Park, Cardiff, UK CF14 4XW
| | - Iolo J. M. Doull
- Department of Paediatric Respiratory Medicine, Children’s Hospital for Wales, Cardiff, UK CF14 4XW
| | - Alison Evans
- Department of Paediatric Radiology, Children’s Hospital for Wales, Heath Park, Cardiff, UK CF14 4XW
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14
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Protic A, Barkovic I, Ivancic A, Kricka O, Zuvic-Butorac M, Sustic A. Accuracy of targeted wire guided tube thoracostomy in comparison to classical surgical chest tube placement - A clinical study. Injury 2015; 46:2103-7. [PMID: 25840790 DOI: 10.1016/j.injury.2015.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/16/2015] [Accepted: 03/07/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Chest tube malfunction, after the tube thoracostomy, is often the result of an inappropriate chest tube tip position. The aim of this study was to analyse the precision of chest tube placement using the targeted wire guide technique (TWG technique) with curve dilator and to compare it to the classical surgical technique (CS technique). MATERIALS AND METHODS In this clinical study 80 patients with an indication for thoracic drainage, due to pneumothorax or pleural effusion were included. Experimental group contained 39 patients whose chest tube was placed using the TWG technique. The control group contained 41 patients whose chest tube was placed using the CS technique. RESULTS The comparison of the outcomes of the two techniques applied suggests that the TWG technique was significantly more successful in achieving adequate (precise) chest tube placement, irrespective of patient diagnosis (TWG vs. CS in all patients, 78.4% vs. 36.6%, p<0.001). In the pleural effusion group, TWG and CS had success rates of 78.2% and 37.5% (p=0.005), respectively, while in pneumothorax group, TWG and CS had success rates of 78.6% and 35.3% (p=0.029), respectively. CONCLUSIONS Using a curved dilator and the TWG technique for the thoracic drainage procedure we found statistically significant advantage to the TWG technique in comparison to the CS technique (78% vs. 37%) regarding precise chest tube placement within the pleural cavity. Introducing the materials and technique used in this clinical trial into clinical practice may improve the quality of thoracic drainage, including residual volume of air and/or fluid, poor functioning of the chest tube, and, as a consequence of both, prolonged hospitalisation.
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Affiliation(s)
- Alen Protic
- Department of Anesthesiology and ICU, University Hospital Rijeka, Rijeka, Croatia.
| | - Igor Barkovic
- Department of Pulmonology, University Hospital Rijeka, Rijeka, Croatia
| | - Aldo Ivancic
- Department of Surgery, University Hospital Rijeka, Rijeka, Croatia
| | - Ozren Kricka
- Department of Pulmonology, University Hospital Rijeka, Rijeka, Croatia
| | | | - Alan Sustic
- Department of Anesthesiology and ICU, University Hospital Rijeka, Rijeka, Croatia
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