Chest Tube Removal: End-Inspiration or End-Expiration?

Bell, Robert L.; Ovadia, Philip; Abdullah, Fizan; Spector, Seth A.; Rabinovici, Reuven

doi:10.1097/00005373-200104000-00013

Cited by 85 publications

(65 citation statements)

References 10 publications

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“…In one study, the removal of the chest tube at the end of inspiration and at the end of expiration was compared, and the Valsalva maneuver was performed in both these groups. No difference was observed between these two groups in terms of the risk of pneumothorax (22). Experimental studies are needed in this regard for the elimination of technical differences, standardization of treatment and care, and use of a valid and reliable method.…”

Section: Discussionmentioning

confidence: 98%

Nurses’ Knowledge Levels of Chest Drain Management: A Descriptive Study

Tarhan¹,

Gökduman²,

Ayan³

et al. 2017

Eurasian J Pulmonol

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Section: Discussionmentioning

confidence: 98%

Nurses’ Knowledge Levels of Chest Drain Management: A Descriptive Study

Tarhan¹,

Gökduman²,

Ayan³

et al. 2017

Eurasian J Pulmonol

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“…Comparing drain removal during end-inspiration and end-expiration, Bell et al (2001) found no difference in the rates of post-removal pneumothorax, although current practice recommends drain removal whilst the child performs a Valsalva manoeuvre or else during expiration. A smooth, swift removal of the drain is preferred to a slow withdrawal.…”

Section: Removal Proceduresmentioning

confidence: 90%

Paediatric chest drains: past, present and percutaneous

Parslow

Sandell

2005

Trauma

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membrane of the embryonic coelomic cavity is invaginated by the growing lung buds. The membrane covering the exterior surface of the formed lung is called visceral pleura; that lining the chest wall being the parietal pleura. The coelomic cavity remains as the slit-like pleural space and contains a thin film of pleural fluid, produced by the pleura. This fluid enables the two layers of membrane to slide over each other during respiration. A negative (subatmospheric) pressure of between Ϫ2.5 mmHg and Ϫ6 mmHg, exists in the pleural space throughout the respiratory cycle (Ganong, 1993). Should the integrity of the pleura be disrupted, the negative intrapleural pressure is lost and air is sucked into the intrapleural cavity creating a pneumothorax. This, in turn, causes the affected lung to collapse due to its inherent elastic recoil. If air continues accumulating in the intrapleural space, the intrapleural pressure on the affected side will approach atmospheric pressure, pushing the mediastinal contents away towards the unaffected side: the clinical manifestations of a tension pneumothorax. This condition is lifethreatening. Air entering the pleural space during inspiration is unable to escape during expiration due to the presence of a valve like communication in the pleura. This accumulation of trapped air within the pleural space collapses the lung on the affected side, compresses the mediastinal structures, impairs venous return to the heart and cardiac output subsequently diminishes. To relieve or decompress this tension pneumothorax a 16-guage cannula (or larger) should be attached to a syringe and inserted through the anterior chest wall in the second Trauma 2005; 7: 163-170The authors present a review of the pathophysiology of pneumothoraces, the indications and the procedures required for the insertion of chest drains, and review paediatric practice using the recently developed Seldinger-style percutaneous chest drains.

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“…24 Bell and colleagues conducted a prospectively compared removal of 102 chest tubes in 69 trauma patients either at end inspiration or end expiration and found no significant difference in the incidence of recurrent pneumothorax. 25 Although unstudied, our practice is to return a previous water seal system to suction for a brief period before removal. This "might help, can't hurt" approach may remove residual air or fluid from the tubing and pleural space.…”

Section: Chest Tube Managementmentioning

confidence: 99%