Wednesday March 8, 2006
Chest tube (tube thoracostomy) with seldinger technique - underutilize technique?
Cannulation of pleural space was first described by Hippocrates (460 B.C) and in modern medicine about 140 years ago by Hillier 1. Chest tube insertion gained huge respect during 2 world wars as a life saving procedure. Over last few decades technique remain mostly unchanged with insertion either with help of trocar or with direct insertion with scalpel/clamp and finger opening of pleural space. In recent years insertion of chest tube with seldinger technique (over guide wire) has been described but still remain less popular, although, it has significant advantages over traditional method as it is less painful, easy to insert, can be master easily and ? less prone to infection. The only disadvantage is inability to 'feel' pleural space. On literature search we were unable to find any head to head study comparing seldinger technique with operative technique. There is only one attempt earlier to check literature (see reference # 2) and found that seldinger technique is no way inferior (or superior either) to traditional chest tube insertion.
Chest tubes are available for seldinger technique insertion upto 36 f size. See details here from Cook (maker of Thal-Quick chest tubes).
Isn't it time to graduate to seldinger technique for chest tubes as we did for central venous catheters from cut-downs? All comments are welcome.
References: (click to get article)
1. Chest tube - int.med.utah.edu
2. Seldinger technique chest drains and complication rate - Emerg Med J 2003; 20:169-170