The needle-wire-dilator technique for the insertion of chest tubes in pediatric patients

We evaluated the needle-wire-dilator (NWD) technique, using commercially available sets, for insertion of chest tubes in 24 pediatric patients who were admitted to our pediatric intensive care unit (PICU). Fourteen patients had pneumothoraces, three had hemothoraces, two had pneumonia with empyema, four had pleural transudate effusions, and one had chylothorax. The ages of the patients ranged from four months to 24 years, and the sizes of the inserted chest tubes ranged from 10F to 20F. All insertions were successful, and the time from invasion of the pleural space by the needle to completion of chest tube insertion and connection to the tubing drainage system ranged from four to seven minutes. In four patients the procedure had to be performed while a significant coagulopathy existed. However, none of the 24 patients developed hemorrhagic complications. The only complication observed was a kink in the chest tube in five patients, resulting in recurrence of pneumothorax in four and pleural effusion in one. These adverse occurrences were corrected by repositioning the chest tubes in three patients, and by replacing the chest tubes with the stiffer, trochar type, chest tubes in the other two. We conclude that the NWD technique for chest tube insertion is quick, safe, and easy to perform in all pediatric age groups. The commercially available chest tubes used in our study were somewhat softer than the trochar type chest tubes available, which explains the occurrence of kinks in some of them.