Do-It-Yourself Seldinger Chest Tube Kits.

[RustedFox]

So at my one job site, we have the Thal-Quick chest tube kits. They're sweet.

I bothered my other job site to get them. We got one. I used it. Big hemopneuothorax on an EtOH-related fall (we have lots of exterior, slippery wet surfaces here in Florida, and even more seniors on anticoagulants; it happens more often than you think).

But I got to thinking; I use maybe 25% of the "stuff" that's in the actual kit. I can do this myself with a central line kit and any small-caliber chest tube by itself... so why don't I do that ?

The technique is pretty self-explanatory:

1. Prep and numb site.
2. Penetrate chest wall with central line needle/syringe; aspirate until you get gas return.
3. Disconnect syringe from needle; thread guidewire thru needle into chest.
4. Dissect a bit with scalpel.
5. Slide chest tube over guidewire.
6. Remove guidewire, secure tube. Get chest x-ray.

The only other tools that I could see being useful are the dilators in the Thal-Quick kit. Anyone care to find any flaws or oversights in my planning here ?

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[southerndoc]

Why wouldn't you use the chest tube kit? Central line kits aren't cheap. We use a Cook Seldinger kit.

 

[RustedFox]

Why wouldn't you use the chest tube kit? Central line kits aren't cheap. We use a Cook Seldinger kit.

I thought I made it clear that we don't have the seldinger kits at the one job site; if you need to reduce a pneumothorax, its old-style scalpel, forceps, and barbarism.

 

[TheBlueBlazer]

Without the dilators to ease the tube in with minimal cutting, I really don't see a whole lot of benefit to doing it with the seldinger technique.

 

[fahimaz7]

I thought I made it clear that we don't have the seldinger kits at the one job site; if you need to reduce a pneumothorax, its old-style scalpel, forceps, and barbarism.

There is some good data that needle aspiration of a pneumothorax (not hemopneumo) is just as good as the chest tube. We use this some at my site. Works decently.

 

[RustedFox]

Without the dilators to ease the tube in with minimal cutting, I really don't see a whole lot of benefit to doing it with the seldinger technique.

I don't even use the dilators. One nice, thin cut. One nice, thin tube.

 

[Groove]

So at my one job site, we have the Thal-Quick chest tube kits. They're sweet.

I bothered my other job site to get them. We got one. I used it. Big hemopneuothorax on an EtOH-related fall (we have lots of exterior, slippery wet surfaces here in Florida, and even more seniors on anticoagulants; it happens more often than you think).

But I got to thinking; I use maybe 25% of the "stuff" that's in the actual kit. I can do this myself with a central line kit and any small-caliber chest tube by itself... so why don't I do that ?

The technique is pretty self-explanatory:

1. Prep and numb site.
2. Penetrate chest wall with central line needle/syringe; aspirate until you get gas return.
3. Disconnect syringe from needle; thread guidewire thru needle into chest.
4. Dissect a bit with scalpel.
5. Slide chest tube over guidewire.
6. Remove guidewire, secure tube. Get chest x-ray.

The only other tools that I could see being useful are the dilators in the Thal-Quick kit. Anyone care to find any flaws or oversights in my planning here ?

Yea, the Thal-Quicks/Pneumodarts, etc.. are nice and easy, depending on what size thoracostomy tube you require. If you're going to use a seldinger approach, you need a full on seldinger kit with the dilators. There's just no easy way to do them without the dilators. You could dissect, but the problem I have with scalpel or sharp dissection is the increased likelihood of nicking the costal neurovascular bundle, along with lung parenchyma if you accidentally stab too deep through the pleura. If I'm going to dissect, I prefer blunt dissection. At that point, you might as well have done it the old fashioned way. You can buy small trocars of all sizes but I don't see the utility of using a smaller trocar over something like a Thal-Quick, or variant.

I guess theoretically, if you could buy triple lumen dilators by themselves, you could use that to dilate or a vascath dilator, etc.. You can buy them in all sizes (depending on what size tube you need). You could also get the wires by themselves and jury rig your own thoracostomy kit but that seems like a lot of trouble for something that's likely to take just as much time to complete.

I honestly just keep it simple. Am I going for air or complex fluid? If air, I go small and toss in a pneumodart. If it's complex fluid (hemo/chylo), I put in a large bore with blunt dissection. I hate trocars and never use them. I love the seldinger kits but have found that most shops don't seem to have them.

 

[southerndoc]

I thought I made it clear that we don't have the seldinger kits at the one job site; if you need to reduce a pneumothorax, its old-style scalpel, forceps, and barbarism.

Excuse me. I missed that.

 

[RustedFox]

Excuse me. I missed that.

It's cool, I still love you.

But for realsies. There's no "chest tube kit" at 2/3 of my job sites. Its; "here's something that belonged in the O.R. ten or so years ago and hasn't been opened since." I found this to be myopic at the very least, and needed a work-around. I just cannot justify the hack-and-slash method in the stable pneumothorax.

 

[Tiger26]

I've used a 16 angiocath (the catheter only) over the wire as a dilator

 

[MSmentor018]

cook is coming out with a metal sleeve attached to the end of the kelly clamp to insert the guide wire through. so just pop the pleura and insert. I did the test model for it last year. works great for the big fatties. rusted fox method seems just as effective....and probably a hell of a lot cheaper!