Are routine post drain removal chest x-rays necessary after oesophagectomy?

Background: Routine chest X-rays (CXR) are often performed following the removal of chest drains placed during oesophagectomy. CXRs are costly and inconvenient for the patient, often being performed out of working hours. The aim of this study was to evaluate whether routine CXR is necessary following drain removal or if CXRs should only be performed when indicated by the clinical status of the patient.Methods: This was a retrospective study of oesophagectomies performed at a single high volume centre. Routine post chest drain removal CXRs were analyzed and compared to baseline post-operative CXRs. The clinical status of the patient before and after chest drain removal was recorded.Results: 188 patients were identified. 111/188 (59%) had a pleural effusion or pneumothorax on their baseline post-operative CXR. Abnormal findings on post drain removal CXR were common with 72/188 (38.3%) patients having a new or worse pleural effusion or pneumothorax. Only, 5.6% (11/188) of these patients actually developed clinical signs after chest drain removal. Of these, only 2.1% (4/188) required chest drain re-insertion. No patients underwent intervention without showing clinical deterioration. No re-intervention was prompted by CXR finding alone.Conclusions: Routine CXR following chest drain removal is unnecessary. It is safe to only perform CXRs on patients who develop clinical signs.

Central Line Induced Pneumothorax: A Case Report

Central venous catheter insertion is a commonly performed procedure. We report a case of central venous catheterization induced pneumothorax in a 45 years old male patient who underwent a surgery for sub-arachnoid hemorrhage and post-surgery, developed tension pneumothorax during internal jugular vein catheterization.

Postoperative drainage with central venous catheter for uniportal video-assisted thoracoscopic surgery lobectomy promotes fast track recovery: A randomized controlled trial / 中国胸心血管外科临床杂志

@#Objective To evaluate the feasibility and safety of improving chest drainage procedure by applying postoperative chest drainage with central venous catheter for uniportal video-assisted thoracoscopic surgery (VATS) lobectomy in fast track recovery. Methods Between July 2016 and March 2018, a total of 150 patients who underwent uniportal VATS lobectomy by the same chief surgeon were recruited. All patients were randomly divided into two groups including a trial group and a control group. In the trial group, there were 44 males and 28 females with an average age of 47±11 years. Central venous catheter and 26F silicone rubber tuber were used and chest tube was removed when drainage volume less than 300 ml/d. Chest X ray was conducted three days after discharge from hospital and the central venous catheter was removed after thoracentesis. In the control group, there were 40 males and 29 females with an average ages of 52±13 years, 26 F silicone rubber tuber and chest tube were removed when drainage volume less than 100 ml/d. The clinical effectiveness was compared between the two groups. Results No statistically significant difference was observed between the trial group and the control group in the date of preoperative general information, the occurrence of postoperative complications and the visual analogue score on Day1 after the operation. However, the visual analogue score, intubation time, post-operative length of stay, the frequency of using tramadol were all significantly shorter or lower in the trial group when compared with the control group (P<0.05). Seven patients of the trial group suffered moderate pleural effusion after intubation, which was significantly more than that of the control group (P<0.05). Six patients recovered after thoracentes through central venous catheter. The average amount of pleural effusions before removing the central venous catheter was 74.8 ml. Conclusion The use of central venous catheter and 26 F silicone rubber tuber after uniportal VATS lobectomy is safe and feasible for the early removal of chest tube. It is beneficial to fast track recovery.

Intercostal drainage tube or intracardiac drainage tube.

Although insertion of chest drain tubes is a common medical practice, there are risks associated with this procedure, especially when inexperienced physicians perform it. Wrong insertion of the tube has been known to cause morbidity and occasional mortality. We report a case where the left ventricle was accidentally punctured leading to near‑exsanguination. This report is to highlight the need for experienced physicians to supervise the procedure and train the younger physician in the safe performance of the procedure.

Garenoxacin as a prophylactic anti-infective in hydropneumothorax: a case study report.

Pneumothorax appears to be a common clinical state. Iatrogenic pneumothorax occurs commonly after procedures such as transthoracic needle biopsy, pleural biopsy, positive pressure ventilation, etc. Diagnosis of iatrogenic pneumothorax is often delayed. Broad spectrum anti-infectives appear to be benefi cial in reducing the infections, especially when chest drains are inserted. Garenoxacin, a potent quinolone with its unique structural modifi cation appears to have an edge over other respiratory quinolones.

Autologous transfusion in a patient with life threatening traumatic haemothorax: Case Report.

Penetrating thoracic injuries frequently presents a challenge to the clinicians. The situation may become more deleterious owing to the unavailability of adequate blood of required group. We discuss the acute management of a patient with life threatening traumatic haemothorax following penetrating thoracic injury. In this patient, autologous transfusion of patient blood collected in chest drain was performed during intraoperative period using an indigenous technique with successful outcome.