Clamping chest tubes

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Hi Norm

I cannot understand this American facination with suction on chest tubes.
We in South Afirca have long given up on routine chest tube suction for
trauma drains (excl thoracic surgery resections - different pathology) and
the average "out time" in non-ventilation ICU patients is under 72 hours
(work published inthe 1980's from Cape Town in BJS and Injury.

Someone please expalin this to me???

I also agree that there is a place to test-clamp, but only for
reacculmmulation of haemothorax. If the patient is on a non-suction chest
tube, has no "bubbling" on coughing or valsalva the chance of missing a
recurrent pneumo is practically zero. Again to qualify - this is NOT
ventilated ICU cases.

Tim
Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Senior Lecturer UKZN Dept Surgery
Deputy Director - IALCH Trauma Service
Durban, South Africa
> Wrong. Always clamp the chest tube and get a 6 hour film before removal.
> This will assure that there is not still a small leak. "Oh you can never
> clamp a tube for fear of a tension pneumothorax"...better for the
> pneumothorax to redevelop with a chest tube in place and to reconnected to
> the suction, without having to re insert it
>
> Norman
> Norman McSwain MD, FACS
> Professor, Tulane School of Medicine
> Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO
> norman.mcswain at tulane.edu
> 504 988 5111
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Rwolfer
> Sent: Thursday, March 17, 2011 6:02 AM
> To: Trauma-List [TRAUMA.ORG]
> Subject: Re: Clamping chest tubes
>
> 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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