Abstract
BackgroundEmergent placement of a chest tube is a potentially life-saving procedure, but rate of misplacement and organ injury is up to 30%. In principle, chest tube insertion can be performed by using Trocar or Non-trocar techniques. If using trocar technique, two different chest tubes (equipped with sharp or blunt tip) are currently commercially available. This study was performed to detect any difference with respect to time until tube insertion, to success and to misplacement rate.MethodsTwenty emergency physicians performed five tube thoracostomies using both blunt and sharp tipped tube kits in 100 fresh human cadavers (100 thoracostomies with each kit). Time until tube insertion served as primary outcome. Complications and success rate were examined by pathological dissection and served as further outcomes parameters.ResultsDifference in mean time until tube insertion (63s vs. 59s) was statistically not significant. In both groups, time for insertion decreased from the 1st to the 5th attempt and showed dependency on the cadaver's BMI and on the individual physician. Success rate differed between both groups (92% using blunt vs. 86% using sharp tipped kits) and injuries and misplacements occurred significantly more frequently using chest tubes with sharp tips (p = 0.04).ConclusionData suggest that chest drain insertion with trocars is associated with a 6-14% operator-related complication rate. No difference in average time could be found. However, misplacements and organ injuries occurred more frequently using sharp tips. Consequently, if using a trocar technique, the use of blunt tipped kits is recommended.
Highlights
Emergent placement of a chest tube is a potentially life-saving procedure, but rate of misplacement and organ injury is up to 30%
The null hypothesis was rejected when the two sided significance level was below 5%. Both tube types were inserted into the same cadavers per physician per day; demographic characteristics are equal in both groups [table 1]
To conclude, in this study, chest drain insertion with trocars is associated with a 6-14% complication rate that is operator related
Summary
Emergent placement of a chest tube is a potentially life-saving procedure, but rate of misplacement and organ injury is up to 30%. Chest tube insertion can be performed by using Trocar or Non-trocar techniques. This study was performed to detect any difference with respect to time until tube insertion, to success and to misplacement rate. Pneumothorax is the most frequent indication for insertion of a chest tube in trauma patients [4,5]. One of two basic techniques to insert a chest tube is usually applied: the trocar or the non-trocar technique. The trocar technique alleviates guidance as compared to non-trocar techniques, but has the potential of increased complication rates [17,18]. A recently described technique using the fingers for exploring the pleural space and simultaneously guiding the trocar improves safety and has shown low complication rates as with the non-trocar techniques [19]
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