Could the original poster clarify if you are talking about the seldinger
aspiration catheters or the full size (upto 36Fr) seldinger chest drains
which utilise dilators.
I have used both - the later provide exactly the same "type" of chest
drain as a standard drain - its only the insertion technique which
varies.
Craig
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Adrian Fogarty
Sent: Friday, 2 November 2007 1:08 p.m.
To: [log in to unmask]
Subject: Re: Seldinger type chest drains
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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