Elsevier

Injury

Volume 26, Issue 6, July 1995, Pages 425-426
Injury

Chest tube insertion in the ventilated patient

https://doi.org/10.1016/0020-1383(95)00055-EGet rights and content

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    Both cases of intraparenchymal malposition occurred in ventilated patients where intubation and positive pressure ventilation had occurred prior to commencing TT. The literature reports high incidence of lung perforation by surgical instruments in the diseased, hyperventilated lung with a high PEEP where the pleural space may be diminished [14,15]. Consideration of protective ventilation strategies such as reducing PEEP or performing an expiratory hold, to prevent iatrogenic injury during pleural decompression and to assist tube passage and safe placement, warrant further study.

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    However, reported complications rates are higher in studies using the trocar technique compared to studies using blunt surgical dissection (11.0% versus 1.6%). Some authors recommend a pause in expiration at the moment of pleural incision in ventilated patients to minimise the risk of parenchymal lung injury (LoE 5).62,100,101 The chest tube is then advanced through the prepared canal either using a finger to direct the catheter tip or to guide it by means of a clamp that holds the tip of the chest tube.

  • Chest drains - An overview

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