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Thu Mar 17 13:19:07 GMT 2011

I don't understand. What's the upside to clamping a chest tube? If there is no upside what's the purpose? Can clamping a chest tube get the tube out of the patient faster? So, on one side we have a very safe procedure which is proven to b safe. On the other side we can look at clamping chest tubes which seems to have little or not potential to get chest tubes out quicker or safer.

Errington C. Thompson, MD
Sent from my iPad

On Mar 17, 2011, at 9:11 AM, KMATTOX at aol.com wrote:

> If one is to clamp a chest tube, it should be for a logical anatomic and  
> physiologic reason, not for mere repetition of culture.      Most local 
> dictums are just that, whether it be for clamping or NOT  clamping.   Here we 
> have not clamped chest tubes because some where in  the far distant past a 
> patient with a continuing air leak had their chest tube  clamped and developed a 
> recurrent pneumothorax which went on to  tension.   So someone made a 
> dictum.     
> 
> So,,,,,, this subject deserves a study and an editorial.    
> 
> k
> 
> 
> In a message dated 3/17/2011 6:04:17 A.M. Central Daylight Time,  
> rwolfer at aol.com writes:
> 
> Never  ever ever clamp tube unless chamging pluevac or doing chemical  
> pleurodesis  then only supervised
> Rw
> 
> Sent from my iPhone so I  can reply quickly so please forgive any errors
> 
> On Mar 17, 2011, at 4:18  AM, "A. E. Ricardo Hamilton" 
> <ricardo_hamilton at yahoo.com>  wrote:
> 
>> Hello all:
>> 
>> I am writing to get your  expert opinion about removing chest tubes that 
> were placed for post-traumatic  pneumothoraces and haemothoraces.  
> Throughout the trauma literature and  guidelines, the firm statement is that one 
> should never clamp drains, other  than immediately before removal or to change 
> the drainage bottle.  
>> 
>> I have come across a few studies that have challenged  this dogma.  These 
> unconventional recommendations have set about specific  and highly 
> supervised algorithms where drains can be clamped to expedite  removal and to 
> decrease the incidence of pre-mature removal.  Some  suggest that clamping, as 
> with cholangio t-tubes, can even predict those  pneumothoraces particularly 
> that might reaccumulate post drain removal.   
>> 
>> At Liverpool, the fail-safe default in Trauma is for  drains never to be 
> clamped for fear of a later unrecognised tension  pneumothorax.  What I 
> wanted your experienced and learned opinions on are  the following, if you can 
> indulge me:
>> 
>> 
>> Are we  in Trauma being too paranoid and is this risk actual or 
> theoretical?
>> Can we use chest tube clamping as a way to test for reaccumulation 
> before the  actual drain is taken out entirely?
>> If so, what is the algorithm to do  this?
>> If so, is there data to support this as comparable or  better?
>> Is there a difference for clamping during pre- drain-removal  between the 
> standard Wishard-type chest tubes and a Seldinger-placed pigtail  catheter?
>> 
>> Thank you for considering my request.  I  am fully committed to learning 
> how to do the best things for patients as  possible and to seek broad-viewed 
> input into how to actually go about  that.  We have a saying in the 
> Caribbean, “that a man is not wise because  he knows all the answers, but because 
> he knows where to go and get  them”.  So, pardon me for bugging you.
>> 
>> Regards,
>> 
>>    Ricardo
>> 
>> A.E. Ricardo Hamilton
>> 
>> Trauma Surgery  Fellow
>> Trauma Department, Liverpool Hospital
>> South Western  Sydney Area Health Network. 
>> Conjoint Associate Lecturer, University  of New South Wales
>> LIVERPOOL BC (Sydney), NSW 1871,  Australia.
>> 
>> Email:       ricardo.hamilton at sswahs.nsw.gov.au
>> 
>> 
>> 
>> 
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Clamping chest tubes