Page 45 - JSOM Winter 2022

TABLE 1 Patient Characteristics by Chest Tube Placement Method
Placement Method
Overall Reactor (RT) Control (OT)
n = 50 n = 25 n = 25
Characteristic (col %) (col %) (col %) p Value
Side Left 25 (50) 13 (52) 12 (48)
–.8907
Right 25 (50) 12 (48) 13 (52)
Post-Mortem Yes 18 (36) 10 (40) 8 (32) .6949
No 32 (64) 15 (60) 17 (68)
Time Minimum 15.7 15.7 19.3
Maximum 82.4 82.4 63.8
Mean 37.9 37.7 38.2 .9125
Median 36.4 35.6 37.1
Standard Deviation 14 17.1 10.4
Surgeon 1 25 (50) 11 (44) 14 (56)
.4054
2 25 (50) 14 (56) 11 (44)
Position Basilar 20 (40) 10 (40) 10 (40)
Mid lung 21 (42) 14 (56) 7 (28)
Apical 8 (16) 1 (4) 7 (28)
Skin 1 (2) 0 (0) 1 (4)
EBL 0 35 (70) 18 (72) 17 (68)
1 10 (20) 4 (16) 6 (24) .8273
>1 5 (10) 3 (12) 2 (8)
Incision Length Minimum 2.1 2.1 2.4
Maximum 5 3.5 5
Mean 3.1 2.7 3.5 .0072
Median 2.9 2.7 3.3
Standard deviation 0.7 0.3 0.7
Injury Yes 9 (18) 7 (28) 2 (8) .0588
No 41 (82) 18 (72) 23 (92)
Injury Type Mediastinal entry 4 (8) 3 (12) 1 (4)
Visceral pleural injury 5 (10) 4 (16) 1 (4)
None 41 (82) 18 (72) 23 (92)
Resolution of Pneumothorax Yes 48 (96) 24 (96) 24 (96)
No 2 (4) 1 (4) 1 (4)
EBL = estimated blood loss.

compared to an average insertion time for the RT group of Complications
37.7 seconds (SD of ± 17.1 seconds). RT T max was 82.4 sec- Complications occurred in 9/50 insertions (18%). The two
onds; T was 15.7 seconds. There was no difference in inser- complications recorded included tube entry into the medi-
min
tion time between groups (p = .91) astinum (4/50, 8%) and visceral pleural injury (5/50, 10%).
Injuries occurred in 8% (2/25) in the OT group, with one tube
Incision Length entering the mediastinum and one tube causing visceral pleu-
The incision length, regardless of method, was 3.1 cm (SD ± ral injury. Neither injury resulted in significant complications
0.7 cm). The RT technique allowed for smaller incision com- (i.e., bleeding, significant air leak, tension physiology, or an-
pared to the OT group (3.5 cm ± 0.7 cm versus 2.7 cm ± 0.3 cm; other serious outcome).
p = .007).
Injuries occurred in 28% (7/25) of RT insertions, with three
Placement tubes entering the mediastinum and four tubes causing visceral
Regardless of method, 98% of insertions (49/50) were effec- pleural injury. These injuries did not result in significant com-
tively placed in the thoracic cavity. Optimal placement was de- plications. Although approaching significance, no difference
fined as either apical or basilar position. Sub-optimal placement was seen in injury rates between RT and OT cohorts (28%
was defined as placement in the mid-lung or fissure. Optimal versus 8%; p = .06). At post-procedural thoracoscopic eval-
placement occurred in 56% of insertions (28/50). Sub-optimal uation, the most common injury was violation of the visceral
placement occurred in 42% (21/50) of insertions. One tube pleura (10%, n = 5 per group). Violation of the mediastinum
(2%) was placed in the subcutaneous space. The OT method was the next most common (8%, n = 4 per group).
resulted in 68% (17/25) appropriately placed tubes, 28%
(7/25) sub-optimally placed tubes, and 4% (1/25) placed in the EBL
extrapleural space. The RT method resulted in 56% (11/25) Overall average EBL was 1 cc, with range of 0–10mL and 70%

optimally placed tubes and 44% (14/25) sub-optimally placed. of insertions yielded 0mL loss. The majority of OT insertions
Novel Hand-Held Device for Chest Tube Insertion | 43