-----Original Message-----
From: The list will be of relevance to all trainees including
undergraduates and [mailto:[log in to unmask]]On Behalf Of
Adrian Fogarty
Sent: Sunday, March 18, 2001 9:01 AM
To: [log in to unmask]
Subject: Re: chest drains
----- Original Message -----
From: <[log in to unmask]>
> I haven't seen any new proposals from the BTS yet but agree a "small"
(10-14
> G) drain for pneumothoraces is ideal, if aspiration has failed. I placed a
12
> G drain after aspiration of a large pneumothorax failed due to persisting
air
> leak this week, and on check xray the drain was coiled 360 degrees in the
pleural
> space but still draining air well...they appear to have a reinforcing
strip
> down one side...
>
> Marten Howes
> Preston
Slightly off the original subject Marten, but should you be aspirating large
pneumothoraces? I find large pneumothoraces inevitably indicate large leaks,
so aspiration is doomed to failure, especially where there is a short
history i.e. the leak has not had time to seal off/heal and therefore
re-leaks as soon as the lung re-expands. I reserve aspiration for smaller
(30% or less) pneumothoraces or those with a longer history (but large ones
usually present early!).
Adrian Fogarty
I think you're being a bit pessimistic Adrian. I reckon of all the "large"
spontaneous pneumothoraces I've attempted to aspirate about 75% have
reinflated completely [or within 10% or so on the check CXR]. Incidentally,
my understanding of the BTS guidelines is that "small" pneumothoraces in
patients without chronic lung disease that are asymptomatic don't need
aspirating and can be "observed" in clinic. Aspiration is reserved for
moderate/large pneumothoraces or small symptomatic ones.
Bill Bailey
A&E Chesterfield
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