That's fantastic. For years I've been stuck on that idea of small tubes for air and big (huge) tubes for fluid. I have asked surgeons occasionally about this and got sneered at. It makes perfect sense. What is in there that needs such a big tube? We actually draw blood through a 20 gauge needle! It's not like we're sucking out lung fragments or anything like that. One of the best segments I've heard for a while.
My question /. concern with a small tube size is what happens once you start getting clots which would obstruct the release of the fluid wanting to be vacated (thus the aim for a larger tube size to allow vacation of clot(s) as well as the blood / fluid). Just a thought from outside the circle / box.
Does mechanism make a difference, ie, blunt=sterile, vs penetrating, all get tubes?? We use small tubes placed with Seldinger technique for spontaneous PNX, interesting that these may be used for empyema or small PNX.
I think with multiple broken ribs, a big contusion and the likelihood of a large air leak, a real tube will probably be needed. But simply by asking the question "do I really need the big tube" I think we will find lots of times the answer is no. If the little tube fails, you can always go back and put in the big mama. For me, I would like you to try the little mama first!
To join the conversation, you need to subscribe.
Sign up today for full access to all episodes and to join the conversation.
Kenneth D. - November 4, 2012 8:21 AM
That's fantastic. For years I've been stuck on that idea of small tubes for air and big (huge) tubes for fluid. I have asked surgeons occasionally about this and got sneered at. It makes perfect sense. What is in there that needs such a big tube? We actually draw blood through a 20 gauge needle! It's not like we're sucking out lung fragments or anything like that.
One of the best segments I've heard for a while.
David W. - November 28, 2012 1:49 AM
My question /. concern with a small tube size is what happens once you start getting clots which would obstruct the release of the fluid wanting to be vacated (thus the aim for a larger tube size to allow vacation of clot(s) as well as the blood / fluid). Just a thought from outside the circle / box.
Mel H. - November 29, 2012 11:52 AM
Much the same as for a large tube, remove and replace, irrigate, ignore and blame...
Kevin M. - December 4, 2012 8:08 AM
Does mechanism make a difference, ie, blunt=sterile, vs penetrating, all get tubes?? We use small tubes placed with Seldinger technique for spontaneous PNX, interesting that these may be used for empyema or small PNX.
Mel H. - December 4, 2012 8:14 AM
I think with multiple broken ribs, a big contusion and the likelihood of a large air leak, a real tube will probably be needed. But simply by asking the question "do I really need the big tube" I think we will find lots of times the answer is no. If the little tube fails, you can always go back and put in the big mama. For me, I would like you to try the little mama first!