TITLE:
A New Approach for Safe Tube Thoracostomy Insertion: An Objective and Subjective Comparison versus Established Techniques
AUTHORS:
Alex Doyle, Thomas White, Anna Hutton, Karen Mcguire, Parvez Moondi, Peter Young
KEYWORDS:
Thoracostomy; Chest Tube; Complications; Guided Blunt Dissection
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.5 No.2,
January
24,
2014
ABSTRACT:
Introduction: Tube
thoracostomy is an invasive procedure, which may result in life-threatening
injury to major organs and blood vessels. We propose a new approach for
inserting tube thoracostomies to improve the safety of this procedure, termed
guided blunt dissection. In this article, we compared the safety of this new
approach with traditional blunt
dissection and two commercially available Seldinger tube thoracostomy kits in
an ex
vivo model. Methods: We recruited 32 clinicians from a variety
of medical specialties with a range
of experience in performing tube thoracostomy. Each clinician was required to
perform tube thoracostomy using all four approaches in a randomised order. Objectively,
each insertion was categorised as “safe” if the lung remained intact and
“unsafe” if the lung deflated. Subjectively, participants were asked to rank
each approach in order of perceived safety on a four-point scale. Statistical
analysis was performed using a Fisher’s exact test. Results: Objectively, guided blunt dissection was
significantly safer than both Seldinger approaches (p 0.0001), but not traditional blunt dissection (p = 0.71). Subjectively, none of the approaches were
felt to be superior. Conclusions:
These data support the conclusions that, in this ex vivo model, the new guided blunt dissection approach
provided a safe method for tube thoracostomy. Guided blunt
dissection produced less lung deflations relative to competing methods,
certainly when compared objectively to Seldinger techniques. Of note, the Seldinger approaches were perceived
by the participants to be as safe despite there being an increased incidence of
lung injury associated with their use in this model. This indicates that it was
not always possible for the clinician to determine when lung injury had
occurred. This potential for lung injury when using Seldinger approaches for
tube thoracostomy should be emphasised.