Novel use of electromagnetic navigation for thoracostomy tube placement

The Thoracostomy and Mediastinal Drains chapter addresses a group of medical devices used to drain intrathoracic collections of fluid or air. A chest (thoracostomy) tube is a broad term used for a variety of hollow catheters used for pleural drainage. Occasionally, the drain is placed in the mediastinum, and in these instances the term mediastinal drain is preferred. Thoracostomy tubes are typically placed in the pleural space for treatment of pneumothorax or pleural fluid. Tube sizes range from 6F to 40F, depending on the clinical scenario. Small catheters are often placed with Seldinger technique, whereas larger tubes are usually placed with blunt dissection. The tube is typically directed towards the apex in the setting of pneumothorax and towards the posterior base for treatment of pleural fluid collections. When interpreting radiographs following chest tube placement, the radiologist should ensure that the tube and sideport are positioned within the pleural space or the desired anatomic location. It is also imperative to exclude intraparenchymal or intrafissural tube placement and tube kinking.

Download Full-text

Ultrasound for confirmation of thoracostomy tube placement by emergency medicine residents

Trauma ◽

10.1177/1460408616649218 ◽

2016 ◽

Vol 19 (1) ◽

pp. 35-38 ◽

Cited By ~ 3

Author(s):

Damali Nakitende ◽

Michael Gottlieb ◽

Jennifer Ruskis ◽

Deborah Kimball ◽

Errick Christian ◽

...

Keyword(s):

Emergency Medicine ◽

Resident Training ◽

Tube Placement ◽

Thoracostomy Tube ◽

Single View ◽

Resident Physicians ◽

Blinded Study ◽

High Degree ◽

Identification Operator ◽

Cadaveric Model

Introduction Thoracostomy tubes are placed in the Emergency Department for numerous indications, including hemothoraces, pneumothoraces, and empyemas. After insertion, a portable single view chest radiograph is typically performed minutes later to confirm thoracostomy tubes position. However, up to 2.6% of thoracostomy tubes are ultimately determined to be misplaced. Failure to adequately drain the chest in a timely manner may have disastrous consequences. Ultrasonography by expert sonographers has been previously described to evaluate thoracostomy tubes position. The purpose of this study was to assess the accuracy of ultrasound for confirmation of thoracostomy tubes placement by Emergency Medicine residents. Methods We conducted a prospective, randomized, blinded study using a cadaveric model for ultrasound confirmation of thoracostomy tube placement by resident physicians. Thirty-five Emergency Medicine residents performed a total of 140 confirmations. The primary outcome of the study was the sensitivity and specificity of EM resident-performed ultrasonography to correctly confirm thoracostomy tube placement. Secondary outcomes included time to identification, operator confidence, and subgroup analysis by resident training level. Results The study demonstrated an overall sensitivity of 100% (95% CI 94–100%) and specificity of 96% (95% CI 87–99%) for intrathoracic placement. Post-graduate year (PGY) 1 EM residents demonstrated 100% (95% CI 76–100%) sensitivity and 100% (95% CI 76–100%) specificity. PGY 2 EM residents demonstrated 100% (95% CI 87–100%) sensitivity and 94% (95% CI 79–99%) specificity. PGY 4 EM residents demonstrated 100% (95% CI 80–100%) sensitivity and 95% (95% CI 75–100%) specificity. The total time to identification was 16 seconds (95% CI 13–19). Overall operator confidence was 4.0/5.0 (95% CI 3.8–4.1). Conclusion Emergency medicine residents were able to quickly identify thoracostomy tube location using ultrasound with a high degree of accuracy in a cadaveric model after a brief educational session.

Download Full-text