Duration Of Tube Insertion Research Articles

The preoperative risk factors of postoperative self-extubation in elderly patients.

Self-extubation of tubes and catheters causes various adverse events in postoperative patients. We investigated preoperative risk factors associated with self-extubation. A matched case-control study. Teikyo University Hospital. Postoperative patients over 50 years old. Sixty-five patients with a comment in the incident report about self-extubation within 7 postoperative days were recruited for the case group. One hundred ninety-five matched patients in the control group were randomly recruited from an electronic medical record. This group was three times larger than the case group. The matching factors were age, sex, type of tube, duration of tube insertion, and year of the incident. Conditional multiple logistic regression analysis was performed. Sixty-five self-extubation events occurred, and constituted 6.5% of 996 postoperative incident reports. Three significant preoperative risk factors were abdominal operation (odds ratio [OR], 3.21; 95% confidence interval [95% CI], 1.05-10.83), history of dementia (OR, 10.71; 95% CI, 1.45-132.55), and preoperative hemoglobin level (OR, 0.77 per 1.0 g/dL increase; 95% CI, 0.62-0.96). Elderly patients with a history of dementia and low preoperative hemoglobin are at a risk of postoperative self-extubation, especially after an abdominal operation. These predictors can contribute to the more effective prevention of perioperative self-extubation.

Small tube thoracostomy (20–22 Fr) in emergent management of chest trauma

BackgroundThe optimal tube size for an emergent thoracostomy for traumatic pneumothorax or hemothorax is unknown. Both small catheter tube thoracostomy and large-bore chest tube thoracostomy have been shown to work for the nonemergent management of patients with traumatic pneumothorax or hemothorax. This study was conducted to compare the efficacy of a small chest tube with that of a large tube in emergent thoracostomy due to chest trauma. Our hypothesis was that there would be no difference in clinical outcomes including tube-related complications, the need for additional tube placement, and thoracotomy, with the replacement of large tubes with small tubes. MethodsA retrospective review of all patients with chest trauma requiring tube thoracostomy within the first 2h from arrival at our emergency department over a 7-year period was conducted. Charts were reviewed for demographic data and outcomes including complications and initial drainage output. Small chest tubes (20–22 Fr) were compared with a large tube (28 Fr). Our primary outcome was tube-related complications. Secondary outcomes included additional invasive procedures, such as additional tube insertion and thoracotomy. ResultsThere were 124 tube thoracostomies (small: 68, large: 56) performed in 116 patients. There were no significant differences between the small- and large-tube groups with regard to age, gender, injury mechanism, systolic blood pressure, heart rate, and injury severity score. Both groups were similar in the posterior direction of tube insertion, initial drainage output, and the duration of tube insertion. There was no significant difference in the primary outcomes of tube-related complications, including empyema (small: 1/68 vs. large: 1/56; p=1.000) or retained hemothorax (small: 2/68 vs. large: 2/56; p=1.000). Secondary outcomes, including the need for additional tube placement (small: 2/68 vs. large: 4/56; p=0.408) or thoracotomy (small: 2/68 vs. large: 1/56; p=1.000), were also similar. ConclusionFor patients with chest trauma, emergent insertion of 20–22 Fr chest tubes has no difference in the efficacy of drainage, rate of complications, and need for additional invasive procedures compared with a large tube (28 Fr).

Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax

Small pigtail catheters appear to work as well as the traditional large-bore chest tubes in patients with traumatic pneumothorax, but it is not known whether the smaller pigtail catheters are associated with less tube-site pain. This study was conducted to compare tube-site pain following pigtail catheter or chest tube insertion in patients with uncomplicated traumatic pneumothorax. This prospective randomized trial compared 14-Fr pigtail catheters and 28-Fr chest tubes in patients with traumatic pneumothorax presenting to a level I trauma centre from July 2010 to February 2012. Patients who required emergency tube placement, those who refused and those who could not respond to pain assessment were excluded. Primary outcomes were tube-site pain, as assessed by a numerical rating scale, and total pain medication use. Secondary outcomes included the success rate of pneumothorax resolution and insertion-related complications. Forty patients were enrolled. Baseline characteristics of 20 patients in the pigtail catheter group were similar to those of 20 patients in the chest tube group. No patient had a flail chest or haemothorax. Pain scores related to chest wall trauma were similar in the two groups. Patients with a pigtail catheter had significantly lower mean(s.d.) tube-site pain scores than those with a chest tube, at baseline after tube insertion (3.2(0.6) versus 7.7(0.6); P < 0.001), on day 1 (1.9(0.5) versus 6.2(0.7); P < 0.001) and day 2 (2.1(1.1) versus 5.5(1.0); P = 0.040). The decreased use of pain medication associated with pigtail catheter was not significantly different. The duration of tube insertion, success rate and insertion-related complications were all similar in the two groups. For patients with a simple, uncomplicated traumatic pneumothorax, use of a 14-Fr pigtail catheter is associated with reduced pain at the site of insertion, with no other clinically important differences noted compared with chest tubes. NCT01537289 (http://clinicaltrials.gov).

Ventilation Tube Treatment in Children with Otitis Media with Effusion

Objective: 1) Discuss the effects of ventilation tube placement on postoperative mastoid growth in children with otitis media with effusion (OME). 2) Show an incidence of postoperative complication, for example, spontaneous extrusion, permanent tympanic membrane perforation. Method: In total, 177 tubes were inserted in 148 ears in 81 children with OME with a mean age of 5.5 years at our hospital from 2001 to 2009. Long-term tubes were used: The T-Tube (Goode) in 87 cases or the Type II tube (Paparella) in 90 cases. Results: The tubes fell out spontaneously in 46%: 61% in the T-Tube group and 32% in the Type II tube group. Postoperative permanent tympanic membrane perforation occurred in 10%. No relationship was observed between the incidence of tympanic membrane perforation and tube type or duration of tube insertion. Postoperative mastoid growth compared to preoperative condition estimated from X-rays was 42%, 55%, 59%, and 65% at 1, 2, 3, and 4 years after surgery, respectively. Retaining the tube in place for more than 3 years was more efficient than doing so for 1 year in terms of mastoid growth statistically. Conclusion: These results indicate that the mastoid air cells grow favorably in children with OME after ventilation tube insertion. The ventilation tube should be removed from the tympanic membrane 3 years or more after insertion from the viewpoint of the mastoid cells growth.

Vagal response to feeding tube insertion in preterm infants: has the key been found?

We prospectively studied the vagal response to feeding tube insertion in eight healthy preterm infants, on three occasions in each infant during the first three weeks of life. Heart rate, oxygen saturation, respiration and cerebral blood flow velocities were assessed before, during and immediately after insertion of an orogastric feeding tube. The whole procedure was recorded on video. The duration and quality of tube insertion and the behaviour of the infant were evaluated from the recordings. Twenty-one measurements in eight infants were evaluated. The heart-rate decrease observed immediately after tube insertion correlated significantly with the duration of tube insertion, the quicker the manipulation, the greater the heart-rate decrease (P = 0.000). The maximal decrease of oxygen saturation after tube insertion correlated with the degree of heart rate deceleration (P = 0.009). Significant alterations of the flow velocities were observed only when the heart rate fell below 80 beats/min. We speculate that such episodes of bradycardia can be avoided by carefully inserting the feeding tube over a period of at least 15 s.