A nice little study for someone would be to use ultrasound to measure the
width of the intercostal spaces and see how that relates to chest drain size
(+/- age, sex, height, weight etc.). It would not entirely answer the final
question (do they block) but would potentially be interesting. There may be
little point in attempting a drainpipe in someone with small IC spaces.
It would only take a couple of days as well - if only I had the time!!!
Anyone fancy doing it?
Simon
NB.Not sure if it has been done before and would need to check.
Simon Carley
SpR in Emergency Medicine
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Evidence based emergency medicine
http://www.bestbets.org
----- Original Message -----
From: "Adrian Fogarty" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, May 01, 2002 11:58 PM
Subject: Re: chest drains - how big??
> > -----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
>
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