>Interestingly, in the last hospital I worked in tubes were supplied without
>trochars, in line with the teaching that one should put them in with
>forceps. This seems to be driven by the surgeons rather than the chest
>physicians, and I suspect it's due to ATLS teaching. Does anyone on the
>list have any opinions as to whether using a plastic introducer is
>acceptable? These are made by Portex, and go in through the proximal drain
>hole on the tube, into its lumen, and out at the distal end. I've found
>they work well, and allow a smaller incision to be used than that necessary
>to admit both tube and forceps.
The important aspect is not necessarily how the actual drain is inserted but
how the pleura is entered. The use of trocar drains encourages forceful
insertion through the pleura without control preventing lung injury. If you
are breaching the pleura first with a blunt technique eg gloved finger, then
it is perfectly reasonable to use a plastic trocar to then guide the
subsequent drain in, provided your hole is large enough in the first place
to allow the drain to enter without forcing.
Richard Steyn
Cardiothoracic Surgery
Liverpool
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