> -----Original Message-----
> From: Hyde, Jonathan [mailto:[log in to unmask]]
> Subject: RE: chest drains - how big??
>
> For air, any size is fine as the whole drainage issue is a simple matter
of
> physics. It doesn't even have to be apical, although it will possibly
make
> things better. The issue of apical and basal drains is an urban myth,
since
> a correctly inserted and sealed drain applied to suction will cause
> expansion of the lung with subsequent expulsion of the pleural contents
> through the only exit possible (i.e the drain), wherever that might be.
> My own experience, with no scientific backing (but many years of inserting
> chest drains for thoracic blood in routine cardiac surgery cases), is that
> drains do block with blood, and even though we use 32F drains as standard
> for cardiac surgery, some of those even block with clots.
> My practice, therefore, is to use nothing smaller than a 28F for trauma.
Fascinating stuff, from an experienced source, and I agree about the
apex/base myth. However, he concedes that even the large drains block with
blood, so can he be sure smaller drains block more readily? It's slightly
reminiscent of the argument many people advance for not using pink
venflons - "the blood haemolyses", "can't transfuse through them" etc. All
nonsense I feel; red cells are around 7 microns in diameter, and even a pink
venflon is around 100 times that dimension. Returning to chest drains, I
find many patients' intercostal spaces only comfortably allow a 24 or 28F
drain, so if someone could reassure me that a smaller drain would suffice, I
would be very interested.
Adrian Fogarty
|