Chest drain devices

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Armed with knife/needle and a strong enough hand, every technique can be dangerous.

If one knows what to do, small size (12Fr) drain inserted over guide wire is LOT less distressing for the patient - and does the job if there is no blood to clot it off.

I am surgically trained so not scared about sharps as the popular belief goes....

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From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Matthew Reeds
Sent: 27 February 2008 11:30
To: trauma-list at trauma.org
Subject: Chest drain devices


For trauma (as in most other cases as well) there is only 1 appropriate chest drain method - a large bore chest drain inserted with an open/blunt dissection technique. Not only will this drain air, but it is wide enough to drain blood and reduce the potential for clotting of the tube. Needless to say, as everyone is no doubt aware having heard it thousands of time, it is inserted WITHOUT the trocar.

As alluded to, the Seldinder technique is used by physicians for patients with spontaneous primary pneumothoraces and medical pleural effusions who don't like the procedure/have no experience of the open/blunt dissection technique - which is in fact relatively easy, quick and simple. The only time I ever use a Seldiner technique are in patients post cardiac surgery where there is a reactive effusion and is not clotted and a Seldinger drain will suffice.

HOWEVER, people mistakenly assume that the Seldinger technique is atraumatic, when this is not the case. I would say that this can be EVEN MORE traumatic than the "traumatic" open/blunt dissection technique. I have seen patients where the needle/guide wire/drain has gone into the lung parenchyma, bronchus, trachea, oesophagus, pulmonary/hilar vessels. great vessels and even the left ventricle. The left ventricle case was when I observed a junior colleague drain a haemothorax and he was pleased that he had successfully drained it as he drained over 1.5l. He was ignorant of the fact he was draining it too well and that the drain was aimed straight at the apex of the heart, pulsating, rapidly draining fresh bright red blood in spurts into the drain bottle and that the patient became rapidly drowsy, pale & SOB!!...........luckily the patient survived as he went straight to theatre for a thoracotomy and oversewing of his cardiac perforation. Just one of the many reasons for not using Seldinder chest drains.

Matthew


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