Outpatient Chest Tube Management
Section snippets
Material and Methods
We reviewed the records of our patients during the past 7 years who were followed up on an ambulatory basis with chest tubes in place for the evacuation of pleural air. Patients with open drains for empyema or with space problems and catheters for pleural effusion were not included. Recorded data included age, sex, procedure, presence or absence of an air leak, duration of outpatient use, complications, and hospital admissions. Failure was defined as hospital admission because of problems with
Results
Outpatient chest tube management was used on 240 occasions in 214 patients. The numbers of episodes and patients are discordant because of instances of recurrent ipsilateral or metachronous contralateral pneumothorax. Table 1 summarizes some of the data. Hospital admission for problems of tube placement or function was required in only 10 cases (4.2%). There were no deaths and no instances of serious infection or acute life-threatening pulmonary complications.
The pneumothorax group included 176
Comment
The use of the Heimlich valve for the outpatient treatment of pneumothorax has been reported in the surgical literature. Mercier and associates [1] noted only one tube complication in 169 cases. In a series of 41 cases, Cannon and associates [2] successfully managed 88% of those that required thoracostomy without hospital admission. Nonetheless, hospital admission, large-bore tubes, and suction remain the standard approach in many institutions [4,5]. Even those who favor small-bore catheters
References (12)
- et al.
Outpatient management of intercostal tube drainage in spontaneous pneumothorax
Ann Thorac Surg
(1976) - et al.
Pneumothorax: a therapeutic update
Am J Surg
(1981) - et al.
Use of the Heimlich valve to shorten hospital stay after lung reduction surgery for emphysema
Ann Thorac Surg
(1996) - et al.
Civilian spontaneous pneumothorax: treatment options and long-term results
Chest
(1989) - et al.
Sequential treatment of a simple pneumothorax
Ann Emerg Med
(1988) - et al.
Treatment of pneumothoraces utilizing small caliber chest tubes
Chest
(1988)
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Evidence-Based Suggestions for Management of Air Leaks
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Portable Chest Drainage Systems and Outpatient Chest Tube Management
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