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Evaluation of performance of two different chest tubes with either a sharp or a blunt tip for thoracostomy in 100 human cadavers

DOI: 10.1186/1757-7241-20-10

Keywords: chest tubes, thoracostomy, cadaver, pneumothorax, hemothorax, pleural effusion, empyema

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Abstract:

Twenty emergency physicians performed five tube thoracostomies using both blunt and sharp tipped tube kits in 100 fresh human cadavers (100 thoracostomies with each kit). Time until tube insertion served as primary outcome. Complications and success rate were examined by pathological dissection and served as further outcomes parameters.Difference in mean time until tube insertion (63s vs. 59s) was statistically not significant. In both groups, time for insertion decreased from the 1st to the 5th attempt and showed dependency on the cadaver's BMI and on the individual physician. Success rate differed between both groups (92% using blunt vs. 86% using sharp tipped kits) and injuries and misplacements occurred significantly more frequently using chest tubes with sharp tips (p = 0.04).Data suggest that chest drain insertion with trocars is associated with a 6-14% operator-related complication rate. No difference in average time could be found. However, misplacements and organ injuries occurred more frequently using sharp tips. Consequently, if using a trocar technique, the use of blunt tipped kits is recommended.Pneumothorax occurs in 5-41% of all thoracic injuries [1-3], and in up to 25% of patients suffering multiple injuries [4,5]. Besides hemothorax, pneumothorax is the most frequent indication for insertion of a chest tube in trauma patients [4,5]. Complications like tube malposition have been reported in up to 25% of attempted insertions of a chest tube [1,6-8]. In an emergency setting, needle decompression is a widely used technique to manage a tension pneumothorax. However, this is an inexact and potentially dangerous technique. It may be ineffective, and requires subsequent chest tube insertion in a significant number of cases [9-13]. Therefore, needle decompression may be considered primarily as a diagnostic manoeuvre. In advanced pre-hospital emergency care, tube thoracostomy serves as the gold standard in treating tension pneumothorax [14]. The success rate

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