A Novel Device With Improved Outcomes for Tube Thoracostomy

Abstract

Introduction: Tube thoracostomy is a common procedure for which competency is expected of all trauma providers, both surgical and nonsurgical. Although surgery residents have fewer complications than other resident specialties, complications relating to position and insertion are reported. We hypothesized the use of our novel chest tube placement device will improve chest tube placement efficiency while maintaining accuracy compared to the open Kelly clamp technique across multiple specialties.

Methods: A swine lab was conducted through an approved Institutional Animal Care and Use Committee device testing protocol. After a preprocedure, tutorial participants placed chest tubes with the device and Kelly clamps through predetermined incision sites. Placement positioning was determined by a postplacement chest X-ray. One way analysis of variance was used for intratechnique comparisons. Time to placement was compared using paired t-test; P- values of <0.05 were considered significant.

Results: Intrathoracic device placement occurred with 94.4% (N = 68) of placements compared to 93.1% (N = 67) of Kelly clamp placements (P = 0.73). The device-placed chest tubes were apically positioned 94.4% (N = 68) compared to 66.7% (N = 48) (P < 0.01) of Kelly clamp-placed chest tubes. Novel device use chest tube placement was significantly faster with a mean time of 39.3 (±27.7) s compared to 61.5 (±38.6) s for the Kelly clamp (P < 0.01).

Conclusions: In this proof of concept study, our chest tube placement device improved efficiency and accuracy in chest tube placement when compared to the open Kelly clamp technique. This finding was consistent across thoracic trauma providers, including general surgery residents.

Keywords: Accuracy; Efficiency; Novel device; Tube thoracostomy.