a) yes, for all those that need drained.
b) yes, if there's little or no blood obvious, then I've started to use
Seldingers here too. I don't believe there's been anything written about
this yet, but it seemed a reasonable thing to try.
I must admit, while Seldingers are very easy to insert (compared with proper
drains, which I still count as one of the most difficult procedures we have
to do), Seldingers do require "active" management post-insertion. I
discovered early on that many chests don't drain very well despite a
perfectly positioned Seldinger. I quickly realised that it's a bit like the
old "open pneumothorax equation", except in reverse. Basically, the internal
diameter of a Seldinger is way too small to allow much airflow, when the
path of least resistance is via the trachea, so, there's no "incentive" for
air to evacuate via the chest drain during normal respiration. So, you need
to make the patient "valsalva" in order to raise intrathoracic pressure
sufficiently to expel the pneumothorax. There are many ways to do this, but
my current favourite is to make the patient blow through a 14 gauge
venflon/cannula (after removing the trocar). That will produce lots of
bubbling in your drainage bottle.
However, as lung expansion proceeds, I've found the Seldinger is more prone
to "plugging up" than a traditional drain, i.e. drainage ceases as the lung
wall plugs the drainage side holes, despite a sizeable pneumo remaining in
another part of the chest - usually apically. My advice here is to use
positioning, i.e. turn the patient on the opposite side, whereupon the lung
will now fall away/the air will rise, thereby freeing up the drain holes
again. The drain will then swing and bubble again, and very quickly you'll
get full expansion.
Basically, you can't just leave them to their own devices the way we could
with old-fashioned drains. They're long narrow tubes, after all, and you
know what they say about long narrow cannulae in trauma: they're not very
good for volume flow.
AF
----- Original Message -----
From: "mark nicol" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, November 01, 2007 2:10 PM
Subject: Seldinger type chest drains
Can I ask how many departments are using seldinger type chest drains a)in
spontaneous pneumothoraces and b) in traumatic pneumothoraces.
Has anyone encountered interface friction with respiratory physicians when
AE has tried to introduce seldinger type chest drains when the respiratory
physicians have tried to say its for their domain.
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