Ann Thorac Surg 2005;79:1070-1071
© 2005 The Society of Thoracic Surgeons
How to do it
A Simple and Effective Method of Preventing Inadvertent Occlusion of Chest Tube Drains: The Corrugated Tubing Splint
Anastasios K. Konstantakos, MDa,*
a Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
Accepted for publication November 25, 2003.
* Address reprint requests to Dr Konstantakos, Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA 02215
akonstan{at}bidmc.harvard.edu
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Abstract
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Inadvertent occlusion of tube thoracostomy drains by normal patient positioning can be not only a nuisance but also a potentially life-threatening problem. A method of splinting the pliable chest tube drains by using corrugated ventilator circuit tubing is described. This relatively simple and quick technique can help to prevent this undesired and potentially dangerous occlusion of chest tube drains.
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Introduction
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The inadvertent occlusion of tube thoracostomy drains can be not only an annoying but also a potentially life-threatening problem [1–3]. Because the tubing is relatively soft and elastic, it is predisposed to frequent bending and potential kinking by both direct pressure and indirect twisting. When the tubing becomes kinked or twisted at right angles, it effectively clamps the tube outflow. This can lead to postoperative lung collapse and recurrent pneumothorax or, in extreme instances, a tension pneumothorax. This can be a particularly vexing problem in patients with persistent postoperative air leaks that depend on continuous pleural apposition to seal.
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Technique
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It is difficult to maintain continuous attention to the positioning of the tubing because patients are continuously moving and lying on the long flexible tubing. It is not uncommon to find on rounds that a patient has slept for hours on the tubing or that the lower portion of the tubing has twisted itself into an occlusion. Indeed, nursing personnel and the patients themselves are simply unable to monitor the tubing consistently and carefully.
A simple solution to this problem is to provide an outer support layer to stiffen the drain tubing. This can be done by using standard corrugated ventilator circuit tubing (length, 183 cm; internal diameter, 22 mm) fitted over the drain tubing. This is done by longitudinally incising the entire length of the ventilator tubing with a pair of trauma scissors. The plastic ventilator tubing is then simply fitted over the drain throughout its entire length (Fig 1). This 182.9-cm length of ventilator tubing very closely approximates the entire length of the drain tubing (Fig 2).
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Fig 1. The ventilator tubing is fitted onto the chest tubing by simply snapping the incised corrugated tubing over the pliable drain tubing. This is done over the entire length of the thoracostomy drain.
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Fig 2. The ventilator tubing effectively splints the thoracostomy tubing over its entire length, thus markedly preventing inadvertent kinking and occlusion of the inner chest tube drain.
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Comment
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Thus, the stiffer outer ventilator tubing effectively splints the more pliable inner drain tubing and can protect it from kinking and occluding when minor external forces are applied (eg, patient positioning). The outer corrugated ventilator tubing not only prevents kinking, but also retards supercoiling and excessive twisting of the inner collection tubing. However, the ventilator tubing is not too stiff to prevent normal motion of the drain tube, and it can be easily removed and reinserted over the original drain tubing. Furthermore, this technique is convenient, because standard corrugated ventilator circuit tubing can be found in nearly any location within the hospital. Moreover, the procedure is relatively inexpensive; the unit cost of a single length of corrugated tubing is approximately $0.62.
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References
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- Cerfolio RJ. Chest tube management after pulmonary resection. Chest Surg Clin North Am. 2002;12:507–527[Medline]
- Kirschner PA. Provocative clamping and removal of chest tubes despite persistent air leak. Ann Thorac Surg. 1992;53:740–741[Free Full Text]
- Cerfolio RJ, Bass C, Pask AH, Katholi C. Predictors and treatment of persistent air leaks. Ann Thorac Surg. 2002;73:1727–1731[Abstract/Free Full Text]
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Abstract
Introduction
