Tube Management Research Articles

Tube thoracostomy during the COVID-19 pandemic: guidance and recommendations from the AAST Acute Care Surgery and Critical Care Committees.

This document provides guidance for trauma and acute care surgeons surrounding the placement, management and removal of chest tubes during the COVID-19 pandemic.

Safety of early discharge with a chest tube after pulmonary segmentectomy.

Early removal of chest tube is an important step in enhanced recovery after surgery protocols. However, after pulmonary resection with a wide dissection plane, such as pulmonary segmentectomy, prolonged air leak, a large volume of pleural drainage and the risk of developing empyema in patients can delay chest tube removal and result in a low rate of completion of the enhanced recovery after surgery protocol. In this study, we aimed to assess the safety of discharging patients with a chest tube after pulmonary segmentectomy. We retrospectively reviewed a single surgeon's experience of pulmonary segmentectomy from May 2019 to September 2019. Patients who fulfilled the criteria for discharging with a chest tube were discharged and provided written instructions. They returned for chest tube removal after satisfactory resolution of air leak or fluid drainage. In total, 126 patients underwent pulmonary segmentectomy. Ninety-five (75%) patients were discharged with a chest tube postoperatively. The mean time to chest tube removal after discharge was 5.6 (range 2-32) days, potentially saving 532 inpatient hospital days. Overall, 90 (95%) patients experienced uneventful and successful outpatient chest tube management. No life-threatening complications were observed. No patient experienced complications resulting from chest tube malfunction. Five (5%) patients experienced minor complications. Overall, all patients reported good-to-excellent mobility with a chest tube. Successful postoperative outpatient chest tube management after pulmonary segmentectomy can be accomplished in selected patients without a major increase in morbidity or mortality.

Outcome of temporary tracheostomy tube‐placement following surgery for brachycephalic obstructive airway syndrome in 42 dogs

To describe the use, complications and outcome of temporary tracheostomy tube placement as part of the management of acute upper airway obstruction in the postoperative period following multi-level airway surgery in patients with brachycephalic obstructive airway syndrome. Retrospective review of records of dogs surgically treated for brachycephalic obstructive airway syndrome that had a temporary tracheostomy tube placed in the postoperative period. Forty-two dogs were included. Median duration of temporary tracheostomy tube placement was 2 days (range 1 to 7). The major complication rate was 83.3%, minor complication rate was 71.4%, resulting in an overall postoperative complication rate of 95.2%. The most common postoperative complications were tracheostomy tube obstruction (32/42), cough (25/42) and tracheostomy tube dislodgement (16/42). Temporary tracheostomy tube management was classified as successful in 97.6%. Dyspnoea was the most common clinical sign in the short-term postoperative follow-up period, while dyspnoea and increased upper respiratory tract noise were the most common clinical sign in the long term. The median duration of follow-up was 251 days. In an appropriate clinical setting, placement of temporary tracheostomy tubes following multi-level airway surgery for brachycephalic obstructive airway syndrome is a useful strategy to manage postoperative airway obstruction, carrying a low mortality rate, and with a complication rate similar to that found in previous reports.

Effect of enhanced recovery after surgery nursing in patients with cervical single-door spinal canal augmentation and angioplasty

Objective To evaluate the application effect of a series of optimized nursing measures under the concept of enhanced recovery after surgery (ERAS) on the perioperative period of patients with posterior cervical single-door spinal canal augmentation and angioplasty. Methods A retrospective cohort study design was used. From April to December 2018, using cluster sampling method, 476 patients admitted to a class third hospital for posterior cervical single-door spinal canal augmentation and angioplasty were selected as research objects. According to whether or not to implement ERAS optimization, the patients were divided into ERAS group with 100 cases and control group with 376 cases. The control group underwent routine measures such as preoperative evaluation and education, blood management, anesthesia points, surgical points, incision closure, pain management, drainage tube management, and prevention of complications. On the basis of routine measures, the ERAS group implemented optimized measures for ERAS on clinical measures such as fasting water and infusion management before surgery, postoperative diet and infusion management, bowel preparation, urinary tube management, and out of bed activities. A self-designed questionnaire was used to investigate the two groups of patients. The general information, implementation of ERAS nursing (preoperative fasting time, the preoperative water cut-off time, the time for anesthesia, the time for surgery, the amount of infusion before surgery, the amount of infusion during surgery, the amount of infusion after surgery, use of indwelling urinary catheters) , recent effect evaluation indicators [length of hospitalization, cost of hospitalization, discharge daily living ability score (Barthel index) , postoperative complications, postoperative urinary retention]and long-term effect evaluation indicators [Japan Orthopedic Association (JOA) score, Neck Disability Index (NDI) score, neck and shoulder pain VAS score, neck and shoulder stiffness and numbness VAS score, 90-day readmission rate]of the two groups were compared. Results A total of 295 cases were included in the study, including 69 cases in the ERAS group and 226 cases in the control group. The study found that there were statistically significant differences between the two groups of patients in terms of preoperative fasting time, the preoperative water cut-off time, the amount of infusion before surgery, the amount of infusion after surgery and the use of indwelling urinary catheters (P 0.05) . The comparison of long-term effects showed that there was no significant difference in the modified JOA score, NDI score, neck and shoulder discomfort and the 90-day readmission rate in the two groups (P>0.05) . Conclusions The application of ERAS nursing in the perioperative period of patients with posterior cervical single-door spinal canal augmentation and angioplasty can effectively reduce patients' fasting time and water cut-off time, use of urinary catheters, which can reduce patients' hospitalization time, but has no significant effect on the long-term effect of surgery. Key words: Perioperative nursing; Enhanced recovery after surgery; Cervical single-door spinal canal augmentation and angioplasty; Effect evaluation

Core Curricular Priorities in the Care of Children With Medical Complexity: A North American Modified Delphi Study.

Previous studies of pediatric residents have identified educational gaps in caring for children with medical complexity. Training opportunities in complex care vary across residency programs. Defining core curricular topics in complex care is a priority in medical education. To identify core topics to include in a standard complex care curriculum for pediatric residents. An initial topic list was generated through literature review and proceedings of national meetings. Expert panelists were identified based on experience in complex care and residency education. A modified Delphi method was used to determine group consensus by asking participants to rate the importance of complex care curricular topics for pediatric residents. Consensus was defined as >70% of experts identifying a topic as essential. There was a predetermined maximum of 3 iterative, electronic survey rounds, with feedback provided to participants between each round. Sixteen experts participated. Response rate was 100% for all rounds. Experts were from the United States (44%) and Canada (56%); most were affiliated with an academic medical center (96%) involved in both inpatient and outpatient care (69%). Eleven topics were identified as essential across 3 rounds: feeding difficulties, pain/irritability, transition, feeding tube management, difficult discussions, team management/care coordination, dysmotility, aspiration, safety/emergency planning, neuromuscular/skeletal issues, and advocacy. Essential topics were organized according to the International Classification of Functioning, Disability and Health. Eleven curricular priorities in complex care were identified across multiple domains of the International Classification of Functioning, Disability and Health framework, serving as a guide for standardized curriculum development for future pediatricians.

The impact of a mandatory online learning package on naso-gastric tube management in adult patients

The impact of a mandatory online learning package on naso-gastric tube management in adult patients

Complications after Chest Tube Removal and Reinterventions in Patients with Digital Drainage Systems.

Introduction: Digital thoracic drainage systems are a new technology in minimally invasive thoracic surgery. However, the criteria for chest tube removal in digital thoracic drainage systems have never been evaluated. We aim to investigate the incidence and predictive factors of complications and reinterventions after drainage tube removal in patients with a digital drainage system. Method: Patients who received lung resection surgery and had their chest drainage tubes connected with a digital drainage system were retrospectively reviewed. Results: A total of 497 patients were monitored with digital drainage systems after lung resection surgery. A total of 175 (35.2%) patients had air leak-related complications after drainage tube removals, whereas 25 patients (5.0%) required reintervention. We identified that chest drainage duration of five days was an optimal cut-off value in predicting air leak-related complications and reinterventions. In multiple logistic regression analysis, previous chest surgery history; small size (16 Fr.) drainage tubes; the presence of initial air leaks, defined as air leaks recorded by the digital drainage system immediately after operation; and duration of chest drainage ≥5 days were independent factors of air leak-related complications, whereas the presence of initial air leaks and duration of chest drainage ≥5 days were independent predictive factors of reintervention after drainage tube removal. Conclusion: Air leak-related complications and reinterventions after drainage tube removals happened in 35.2% and 5.0% of patients with digital thoracic drainage systems. The management of chest drainage tubes in patients with predictive factors, i.e., the presence of initial air leaks and duration of chest drainage of more than five days, should be treated with caution.

Center Variation in Chest Tube Duration and Length of Stay After Congenital Heart Surgery

Nearly every child undergoing congenital heart surgery has chest tubes placed intraoperatively. Center variation in removal practices and impact on outcomes has not been well described. This study evaluated variation in chest tube management practices and outcomes across centers. The study included patients undergoing any of 10 benchmark operations from June 2017 to May 2018 at participating Pediatric Acute Care Cardiology Collaborative (PAC3) and Pediatric Cardiac Critical Care Consortium (PC4) centers. Clinical data from PC4 centers were merged with chest tube data from PAC3 centers. Practices and outcomes were compared across centers in univariate and multivariable analysis. The cohort included 1029 patients (N= 9 centers). Median chest tube duration varied significantly across centers for 9 of 10 benchmark operations (all P ≤ .03), with a "model" center noted to have the shortest duration for 9 of 10 operations (range, 27.9% to 87.4% shorter duration vs other centers across operations). This effect persisted in multivariable analysis (P < .0001). The model center had higher volumes of chest tube output before removal (median, 8.5 mL/kg/24 h [model] vs 2.2 mL/kg/24 h [other centers]; P< .001], but it did not have higher rates of chest tube reinsertion (model center 1.3% vs 2.1%; P= .59) or readmission for pleural effusion (model center 4.4% vs 3.0%; P= .31), and had the shortest length of stay for 7 of 10 operations. This study suggests significant center variation in chest tube removal practices and associated outcomes after congenital heart surgery. Best practices used at the model center have informed the design of an ongoing collaborative learning project aimed at reducing chest tube duration and length of stay.

Degradation and reduction of small punch creep life of service-exposed Super304H steel

To ensure the safety and structural integrity of a power boiler in thermal power plants, residual life management of superheater tubes at elevated temperature is needed. Over the decades, small punch (SP) creep testing has been widely used as an effective method for measuring creep life and creep properties of the boiler tube materials. In this study, a series of SP creep tests were performed at 650 °C with virgin and service-exposed Super304H stainless steels. The service period was 54750 h and 68550 h, respectively. The residual creep rupture life of the 68550 h serviced Super304H material decreased significantly when it was compared with the virgin and 54750 h serviced materials. Coarsening of the M23C6 precipitates along the grain boundaries made the adjacent region Cr-depleted, which could accelerate the formation of creep cavities at the grain boundaries. These microstructural degradations reduced the creep rupture life of the service-exposed materials. The Larson–Miller curve and the Monkman–Grant relationship were applied to predict the creep rupture life of service-exposed Super304H steels from the measured short creep rupture data.

Intrapleural Impedance Sensor Real-Time Tracking of Pneumothorax in a Porcine Model of Air Leak

In patients with alveolar-to-pleural air leak due to recent surgery or trauma, clinicians tend to manage chest tubes with suction therapy. Nonsuction therapy is associated with shorter chest tube duration but also a higher risk of pneumothorax. We sought to develop an intrapleural electrical impedance sensor for continuous, real-time monitoring of pneumothorax development in a porcine model of air leak as a means of promoting nonsuction therapy. Using thoracoscopy, 2 chest tubes and the pleural impedance sensor were introduced into the pleural space of 3 pigs. Continuous air leak was introduced through 1 chest tube by carbon dioxide insufflation. The second chest tube was placed to suction then transitioned to no suction at increasingly higher air leaks until pneumothorax developed. Simultaneously, real-time impedance measurements were obtained from the pleural sensor. Fluoroscopy spot images were captured to verify the presence or absence of pneumothorax. Statistical Analysis Software was used throughout. With the chest tube on suction, a fully expanded lung was identified by a distinct pleural electrical impedance respiratory waveform. With transition of the chest tube to water seal, loss of contact of the sensor with the lung resulted in an immediate measurement of infinite electrical impedance. Pneumothorax resolution by restoring suction therapy was detected in real time by a return of the normal respiratory impedance waveform. Pleural electrical impedance monitoring detected pneumothorax development and resolution in real time. This simple technology has the potential to improve the safety and quality of chest tube management.

Simulation in midwifery education: A descriptive explorative study exploring students’ knowledge, confidence and skills in the care of the preterm neonate

Undergraduate midwifery programs across Australia have embedded simulation into their curriculum although there is limited but emerging evidence to support the use of simulation as an effective teaching strategy. The purpose of this study was to evaluate the impact that a simulated learning activity (insertion and management of a neonatal nasogastric tube), had on midwifery students' knowledge, confidence and skills post-simulation, and on completion of a clinical placement. A descriptive explorative study was undertaken in two phases. Phase 1: Midwifery students (n = 60) completed a purpose-designed questionnaire to assess their knowledge, confidence and skills, pre and post simulation. Phase 2: Students (n = 46) repeated the questionnaire to reassess their knowledge, confidence and skills after the completion of a neonatal nursery placement. The findings demonstrate that simulation is an effective learning strategy in an undergraduate midwifery program. Students' knowledge, confidence and skills increased significantly post-simulation activity (p0.001). A further increase in these areas was noted post-placement. Key aspects that contributed to student learning included; the demonstrators’ level of knowledge, expertise and currency of practice, as well as the role the student assumes in the simulation activity.

NP02 - Management of nephrostomy tubes: Evidence and issues

NP02 - Management of nephrostomy tubes: Evidence and issues

Nursing Care and Management of Gastrostomy and Gastojejunostomy Tubes in the Pediatric Population

Nursing Care and Management of Gastrostomy and Gastojejunostomy Tubes in the Pediatric Population

Nursing Care and Management of Gastrostomy and Gastojejunostomy Tubes in the Pediatric Population

Nursing Care and Management of Gastrostomy and Gastojejunostomy Tubes in the Pediatric Population

1752 Boerhaave's Syndrome Was Treated With Over-the-Scope Clip OTSC Closure (Bear Claw Closure): A Rare Case Report

INTRODUCTION: Boerhaave's syndrome a rare yet frequently fatal diagnosis, is characterized by transmural rupture of the esophagus. The classic presentation of Boerhaave syndrome is characterized by Mackler's triad, consisting of chest pain, vomiting, and subcutaneous emphysema. Boerhaave syndrome can occur in patients with a normal underlying esophagus or pathological esophagus, such as eosinophilic esophagitis, Barrett's and malignancy. Rupture of the esophagus results in contamination of the mediastinal cavity with gastric contents, and subsequently bacterial infection and mediastinal necrosis. Surgical treatment is well established, but the development of interventional endoscopy has proposed new therapies. CASE DESCRIPTION/METHODS: 57 year-old male presented with trauma in setting of alcohol intoxication. In the ED patient was found to have a left hemopneumothorax found in CT scan. The patient was admitted for lactatemia and chest tube management. Afterwards patient developed sepsis due to empyema which prompted him to undergo for VATs procedure. Patient remained septic and CT with contrast revealed an esophageal leak and Boerhaave’s syndrome was suspected. GI was consulted and patient underwent EGD. A 8 mm perforation was found in the left latero-posterior portion of the esophagus consistent with Boerhaave syndrome. To repair the defect, the tissue edges were approximated using suction and one 11 mm OTSC was successfully placed (Bear claw). Thereafter patient underwent g-tube and j-tube placement. Next, the patient was discharged home and was seen in the clinic, where the g-tube and j-tube was removed. DISCUSSION: The current management of BS includes conservative, endoscopic, and surgical treatments. The survival rates for each treatment are 75%, 100%, and 81%, respectively. The estimated mortality rate of patients with BS is 20%–40%. Endoscopy can be utilized to confirm the diagnosis of BS, particularly in equivocal cases. Endoscopic treatment with stenting can be effective and less invasive. In a systematic review that, endoscopic stenting had a success rate of 81% but endoscopic intervention was required in 17% and surgical reintervention in 10% patients. More recently, the use of OTSC has been reported in treatment of boerhaave’s alone or in combination with local therapies or esophageal stent. These endoscopic interventions are typically performed within several days of the perforation. Here we report successful closure of boerhaave with use of OTSC alone after 14 days from perforation.

Chest Tube Management for Pleural Disease in Pediatrics

Abstract Pleural disease involves a specific component of the respiratory system—the pleura. Treatment of pleural disease frequently involves drainage of the pleural space to return pressure dynamics, and thus respiratory function, to a normal state. This article discusses the contribution of the pleura to healthy respiratory function, diseases of the pleural system, and treatment of pleural disease, with specific attention to drainage by chest tube in the pleural space. Complications and troubleshooting of drainage systems will be discussed. Finally, how to manage pleural disease and treatments within the context of patient- and family-centered care are reviewed.

P1.16-23 Comparison of Electronic and Traditional Thoracic Drainage Systems for Postoperative Chest Tube Management After Pulmonary Resection

P1.16-23 Comparison of Electronic and Traditional Thoracic Drainage Systems for Postoperative Chest Tube Management After Pulmonary Resection

Endotracheal tube management during mechanical ventilation: less is more!

Endotracheal tube management during mechanical ventilation: less is more!

Tracheal Ultrasound for the Accurate Confirmation of the Endotracheal Tube Position in Obese Patients.

Obesity is a serious disorder that may lead to numerous difficulties in endotracheal tube (ETT) management. This study investigated the potential of tracheal ultrasound (TUS) for the accurate confirmation of the ETT position in obese patients. A total of 68 obese patients undergoing tracheal intubation were enrolled in this study from January 2017 to June 2018. All patients received auscultation and TUS to evaluate the ETT position, which was ultimately verified by bronchoscopy. A correct position of the ETT was defined as placement at the trachea, whereas placement at the right/left main bronchus was classified as an incorrect position. We found 58 correct placements of the ETT at the trachea, 8 incorrect placements at the right main bronchus, and 2 incorrect placements at the left main bronchus. Compared with auscultation, TUS showed higher accuracy (85.29% versus 67.65%; P = .005), sensitivity (84.48% versus 67.24%; P = .005), and specificity (90.00% versus 70.00%; P < .001), as well as lower rates of false-positive (10.00% versus 30.00%; P < .001) and false-negative (15.52% versus 32.76%; P = .005) results for detecting the correct placement of the ETT, defined as placement at the trachea. Tracheal ultrasound is highly sensitive and specific in confirming the ETT position in obese patients.

Nursing the feline patient following surgical management of idiopathic pericardial effusion by subtotal pericardiectomy

A 4-year-old feline was admitted to the veterinary hospital for haemorrhagic pericardial effusion leading to cardiac tamponade of unknown origin. Concurrent subclinical hypertrophic cardiomyopathy (HCM) was also diagnosed. After significant diagnostic tests and reoccurrence of the effusion, the patient underwent a subtotal pericardiectomy. Results were consistent with neutrophillic/granulomatous pericarditis of unknown origin. This article discusses the nursing care implemented postoperatively, focusing on the major themes of pain management, pain scoring, management of the thoracostomy tube and the correction of dehydration and maintaining the patient's nutritional requirements. After 7 days of hospitalisation, the patient recovered well and was discharged.