Optimal Initial Positioning of Chest Tubes to Prevent Retained Hemothorax Using a Novel Steerable Chest Tube With...

Area of Science:

• Medical Devices
• Thoracic Surgery
• Trauma Care

Background:

• Chest trauma frequently causes pneumothorax and hemothorax, necessitating chest tube placement for optimal management.
• Incomplete drainage due to suboptimal tube positioning can lead to retained hemothorax, complicating recovery.
• Current chest tube placement methods may not ensure accurate positioning within fluid or air collections.

Purpose of the Study:

• To develop and evaluate a novel steerable chest tube for accurate placement in the pleural space.
• To assess the ability of the steerable chest tube to achieve desired positions for optimal drainage.
• To incorporate an infusion cannula for targeted instillation of medications.

Main Methods:

• A triple-lumen steerable chest tube was designed with a pull-wire mechanism for controlled angulation.
• In vitro testing quantified the relationship between pull-wire tension and tube arc.
• Feasibility of accurate placement was studied in cadavers and anesthetized pigs using fluoroscopic guidance.

Main Results:

• In vitro studies demonstrated that thumbwheel turns created significant tube angulation (70°-90°).
• Cadaver and animal studies showed consistent success in placing the tube tip in targeted locations (diaphragm or apex).
• Surgical residents with minimal training successfully placed the steerable chest tubes.

Conclusions:

• Preliminary studies confirm the steerable chest tube's capability for accurate and desired positioning.
• The integrated cannula allows for medication instillation, potentially aiding clot lysis and maintaining patency.
• Further studies are planned to validate the device's efficacy in preventing retained hemothorax.