chest tube management

[unchartedem]

I had a patient whom had a large right sided PTX. A chest tube was placed to waterseal. CXR showed persistent PTX(no re-expansion) after the CT was placed. Should I be calling CT surgery immediately or should I give it sometime with suctioning?

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[pseudoknot]

Why wasn't it initially put to suction instead of water seal? Is there an air leak? Did you check all the connections? Is it kinked?

 

[unchartedem]

Ive read some studies that show no change in improvement of expansion if done with suction or without. (at least initially). Connections were fine and tube wasn't kinked. In this situation would you still give it a day or so?

 

[jdh71]

Ive read some studies that show no change in improvement of expansion if done with suction or without. (at least initially). Connections were fine and tube wasn't kinked. In this situation would you still give it a day or so?

Yes (assuming the CT is actually in the chest, and not gone wandering in the chest wall). As long as the patient isn't symptomatic and you've got an air leak (make the patient cough to check if the air leak is slow).

Chest tubes for pneumo shouldn't need suction, though we all do it.

What was the etiology for the pneumo?

 

[Hernandez]

Etiology of ptx?
Size of ct?
Is it clotted off?
If is a smaller pigtail, Does the ct flush?
is it in a fissure?
Symptomatic?
Air leak?
Is the pt on oxygen?

 

[unchartedem]

Patient had COPD which I think was the cause.
It was a size 20 CT. It was not clotted off. Patient was on NRB. Sats 98%. Air leak was present.

 

[Hernandez]

Patient had COPD which I think was the cause.
It was a size 20 CT. It was not clotted off. Patient was on NRB. Sats 98%. Air leak was present.

Then does this cat have a BP fistula? Rhetorical question.

 

[jdh71]

Patient had COPD which I think was the cause.
It was a size 20 CT. It was not clotted off. Patient was on NRB. Sats 98%. Air leak was present.

Patience. These patients need patience.

 

[europeman]

They def need suction if leak large


European

 

[gasflea]

are you sure the ptx on cxr isn't a non-ruptured bulla?