Chest tube management following two row vertebral body tethering for adolescent idiopathic scoliosis.

BACKGROUND: The current gold standard of scoliosis correction procedures is still posterior spinal fusion, an extensively studied procedure. anterior vertebral body tethering is a newer surgical technique for the correction of scoliotic curves. Consequently, best practices have yet to be determined. METHODS: A single-institution, retrospective, review of all patients diagnosed with adolescent idiopathic scoliosis who underwent two row anterior vertebral body tethering between June 2020 and April 2022 was performed. RESULTS: Over the study period, 95 patients met inclusion: 79 females (83.2%) and 16 males (16.8%), age 14.4 ± 2.5 years, with a body mass index of 20.0 ± 2.9, and an average of 8.4 ± 2.1 levels treated. 28 (29.5%) procedures were for double curves and 67 (70.5%) for single curves. After tethering, a chest tube was positioned in each corrected side. A total of 123 chest tubes were analyzed, including 67 single curves and 28 double curves. Average chest tube duration was 2.5 ± 1.1 days and average length of stay was 5.0 ± 2.0 days. Average chest tube output eight hours prior to removal was 61.1 ± 45.6 mL. There was no significant difference in average length of stay for patients who underwent correction of a single curve versus a double curve nor was there a difference in average length of stay or chest tube duration for revisions compared to primary procedures. For the entire cohort, 30-day emergency department visit rate was 7.4% (n = 7) and readmission rate was 4.2% (n = 4). CONCLUSIONS: This early review of a 2-year two row vertebral body tethering postoperative experience provides a report of a safe and effective approach to chest tube management at a single academic center.

Cryoablation Catheter Used in the Surgical Treatment of Atrial Fibrillation May Treat Chest Tube Pain: Engin Technique.

Postoperative pain after cardiac surgery plays an important role in the patient's recovery process. In particular, pain at the chest tube site can negatively affect the comfort and recovery of these patients. Effective pain control minimizes the risk of many complications. Oral and intravenous analgesics, epidural anesthesia, paravertebral block, and intercostal nerve blockade are used in chest tube pain control. We routinely use the surgical cryoablation method in the presence of atrial fibrillation in the preoperative period of cardiac surgery in our clinic. Here we aimed to describe our method of using the cryoablation catheter for intercostal nerve blockade.

Persistent air leak secondary to pneumothorax in COVID-19: A case report and review of literature.

An air leak is a pathologic communication between an area of the endobronchial tree and the pleural space, causing continued air flow. The communication can originate from a distal portion of the airway, causing an alveolar-pleural fistula, or from a more proximal airway, causing a bronchopleural fistula. When the air leak persists beyond 5-7 days, it is classified as persistent air leak (PAL). PAL has serious implications on patient management and outcomes, such as prolonged chest tube maintenance, high rate of infections, ventilation-perfusion mismatch, and prolonged hospital stay with higher morbidity and mortality. There are currently no guidelines for the management of PAL in COVID-19 patients. We presented a case of PAL in a patient with COVID-19-associated pneumothorax successfully treated with a one-way endobronchial valve. We also reviewed current published cases of PAL secondary to COVID-19-associated pneumothorax and the various methods they were treated. The first line treatment was insertion of one or more chest tubes, but the persistence of an air leak then led to other treatment modalities. Initial early surgical evaluation followed by pleurodesis is recommended for the management of PAL. The most common surgical approaches include VATS or open thoracotomy with mechanical or chemical pleurodesis or pleurectomy. However, surgery is not always a feasible option for critically ill patients. In such cases, there are multiple less invasive options for the management of PAL, including implantable devices, such as Watanabe spigots and stents, and chemical agents, such as thermal treatments, hemostatic substances, and tissue adhesives.

Cryoablation Catheter Used in the Surgical Treatment of Atrial Fibrillation May Treat Chest Tube Pain: Engin Technique

ABSTRACT Postoperative pain after cardiac surgery plays an important role in the patient's recovery process. In particular, pain at the chest tube site can negatively affect the comfort and recovery of these patients. Effective pain control minimizes the risk of many complications. Oral and intravenous analgesics, epidural anesthesia, paravertebral block, and intercostal nerve blockade are used in chest tube pain control. We routinely use the surgical cryoablation method in the presence of atrial fibrillation in the preoperative period of cardiac surgery in our clinic. Here we aimed to describe our method of using the cryoablation catheter for intercostal nerve blockade.

Empyema necessitans (EN) as a rare complication of tuberculosis - A case report.

INTRODUCTION: Empyema necessitans (EN) is an uncommon condition where an intrathoracic empyema extends into surrounding extra-thoracic tissues. This case report presents a rare instance of tuberculous EN in an immunocompetent individual. PRESENTATION OF CASE: We present a case of a healthy young male with complaints of weight loss and a chest wall swelling, initially treated as a subcutaneous abscess. He had a history of TB contact and initial laboratory tests showed elevated CRP and ESR, with no bacterial growth on initial culture from FNAC sample. Subsequent imaging revealed the presence of pleural empyema. Following surgical intervention, a connection between fluid collection outside the thoracic wall and the pleural cavity was identified. Diagnosis of tuberculous EN was made on results of second culture of the fluid collection. The patient was further treated with anti-tuberculous treatment. DISCUSSION: EN, rare extrapulmonary complication of tuberculosis, is challenging to diagnose due to nonspecific symptoms and paucibacillary nature of extrapulmonary TB. Imaging plays a crucial role in diagnosis. A multidisciplinary approach involving surgery and anti-tuberculous treatment is effective in managing EN. CONCLUSION: This case underscores the scarcity of EN occurrences and emphasizes the potential for latent TB to surface as atypical complications. Accurate diagnosis requires a combination of clinical insight, imaging, and laboratory tests. EN should be considered in individuals with chest wall masses, particularly in TB endemic areas, and those with a history of TB contact. Treatment involves surgical intervention and anti-tuberculous therapy.

A Case Report of Recurrent Pneumothorax: A Rare Complication of Tricuspid Valve Endocarditis.

Intravenous drug use (IVDU) is a recognized risk factor for infective endocarditis (IE), with potential mechanisms involving direct bacterial introduction through the needle puncture. Bilateral pneumothorax, an under-reported yet significant complication of IE, was first documented in 1990. Only eleven cases of spontaneous pneumothorax (PTX) associated with septic pulmonary embolism from IE have been reported. We present a 26-year-old female with a history of IE and a prior pneumothorax. She was transferred to our facility for recurrent IE, confirmed by echocardiography and blood cultures. After an initial stable clinical course, on the fifth morning, she developed new-onset dyspnea, later diagnosed with bilateral PTX that required bilateral chest tube placement. Left-sided PTX resolved quickly, while the right-sided PTX persisted for 11 more days. Following clinical improvement, the patient was discharged on the 18th day. Promptly identifying this rare complication was crucial for the patient's survival.

Plasma Calcium Level and C-Reactive Protein Albumin Ratio Affect Severe Bleeding After Coronary Artery Bypass Grafting.

OBJECTIVE: In this study, we aimed to determine whether plasma calcium level and C-reactive protein albumin ratio (CAR) as well as other demographic and hematological markers are related in predicting severe bleeding after coronary artery bypass grafting (CABG). METHODS: A total of 227 adult patients who underwent CABG at our hospital between December 2021 and June 2022 were prospectively studied. Total amount of chest tube drainage was evaluated within the first 24 hours postoperatively or until the patient was re-explored for bleeding. The patients were divided into two groups - Group 1, patients with low amount of bleeding (n=174), and Group 2, patients with severe bleeding (n=53). Univariate and multivariate regression analyzes were performed to determine independent parameters related to severe bleeding within the first 24 hours after surgery. RESULTS: When the groups were compared in terms of demographic, clinical, and preoperative blood parameters; cardiopulmonary bypass time and serum C-reactive protein (CRP) levels were found to be significantly higher in Group 2 compared to the low bleeding group. In addition, lymphocytes, hemoglobin, calcium, albumin, and CAR were found to be significantly lower in Group 2. In multivariate analysis, calcium, albumin, CRP, and CAR were found to be independent predictors of significant association with excessive bleeding. A cut-off value of 8.7 (94.3% sensitivity and 94.8% specificity) for calcium and 0.155 (75.4% sensitivity and 80.4% specificity) for CAR predicted excessive bleeding. CONCLUSION: Plasma calcium level, CRP, albumin, and CAR can be used to predict severe bleeding after CABG.

A retrospective comparison between digital to conventional drainage systems for secondary spontaneous pneumothorax related to diffuse interstitial lung disease.

INTRODUCTION: Secondary spontaneous pneumothorax (SSP) occurs as one of the complications associated with interstitial pneumonia (IP). Chest drainage is performed when there is a large volume of air in the pleural space. Notably, SSP with IP (SSP-IP) is frequently not curable by chest drainage only. A digital drainage system (DDS) provides an objective evaluation of air leakage and maintains a pre-determined negative pressure, compared to an analog drainage system (ADS). Few studies have reported the effectiveness of DDS in the treatment of SSP-IP. This study aimed to assess the usefulness of DDS for SSP-IP. METHODS: This retrospective study included patients with SSP-IP who had undergone chest drainage. We reviewed the included patients' medical records, laboratory data, computed tomography findings, and pulmonary function data. RESULTS: DDS was used in 24 patients and ADS in 49 patients. The mean duration of chest drainage was 11.4 ± 1.9 days in the DDS group and 14.2 ± 1.3 days in the ADS group, which was not significantly different (p = 0.218). Surgery, pleurodesis, and/or factor XIII administration were performed in 40 patients. Additionally, five (20.8%) patients in the DDS group and nine (18.4%) in the ADS group had a recurrence of pneumothorax within 4 weeks (p = 1.000). One patient (14%) in the DDS group and six (12.2%) in the ADS group (p = 0.414) were cured of pneumothorax but later died. CONCLUSION: DDS did not demonstrate a significant difference in the shortening of chest drainage duration. Further study is needed to validate the results of this study.

Early Water Seal of Chest Tubes Following Video-Assisted Thoracic Surgery Pleurodesis.

INTRODUCTION: Early water seal following minimally invasive pulmonary lobectomy has been shown to reduce chest tube duration and postoperative length of stay (LOS). We evaluated chest tube duration and postoperative LOS following a standardized chest tube management protocol change (water seal on postoperative day 1) after video-assisted thoracic surgery (VATS) pleurodesis. METHODS: We identified adult patients undergoing VATS pleurodesis from August 2013 to December 2021. The chest tube protocol was changed in January 2017 such that patients were placed to water seal on the morning of postoperative day 1. Patients were divided into two groups, before the change (Group 1: August 2013-December 2016) and after (Group 2: January 2017-December 2021). We compared demographics, clinical characteristics, operative details, postoperative chest tube duration and output, and postoperative LOS between the groups. Descriptive statistics and log-transformed multivariable linear regression models were used to identify differences in patient outcomes that were associated with the protocol change. RESULTS: A total of 488 patients underwent VATS pleurodesis during the study period (Group 1: 329 patients; Group 2: 159 patients). The median age was 61 y (interquartile range [IQR] 49-68), 51% were females, 69% were White, and 29% were Black. For postoperative LOS, Group 1 had an IQR of 3-7 d, while Group 2 had an IQR of 2-6 d (P < 0.001). The multivariable log-transformed linear regression models demonstrated that the practice change was associated with reduced chest tube duration (0.77 times the chest tube duration before the change; P < 0.001) and reduced LOS (0.81 times the LOS before the change; P = 0.006). There was an associated reduction in patients needing to return to the operating room (P = 0.048) and needing postoperative extended ventilatory support (P = 0.035). CONCLUSIONS: Development of a standardized protocol to water seal chest tubes on postoperative day 1 following VATS pleurodesis is associated with reduced chest tube duration and LOS without an increase in postoperative complication rates.

Cuidados de enfermagem ao paciente adulto com drenagem torácica: protocolo de scoping review / Nursing care to adult patient with chest drainage: scoping review protocol

OBJETIVO: mapear os cuidados de enfermagem empregados aos pacientes adultos com drenagem torácica internados em terapia intensiva. MÉTODO: scoping review a ser conduzida conforme o Joanna Briggs Institute, com a seguinte questão de pesquisa: "quais são os cuidados de enfermagem indicados aos pacientes adultos com drenagem torácica internados em terapia intensiva?". A busca será desenvolvida em cinco bases de dados: Pubmed, Scopus, Embase, BVS e Web of Science, e os achados serão geridos com o auxílio do software Rayyan. Serão incluídos estudos quantitativos e qualitativos, artigos de revisão, dissertações, teses, diretrizes clínicas e protocolos terapêuticos sobre a temática, incluindo a literatura cinzenta. Será descrito o número total de fontes de evidência encontradas e selecionadas. Através de uma narrativa, será detalhado o processo de decisão da inclusão dos estudos. Os principais achados deverão estar descritos em consonância com o objetivo e os resultados relacionados à questão de pesquisa.

OBJECTIVE: to map nursing care employed to adult patients with chest drainage admitted to intensive care. METHOD: scoping review to be conducted according to the Joanna Briggs Institute, with the following research question: "What are the nursing cares indicated to adult patients with chest drainage admitted to intensive care?". The search will be developed in five databases: Pubmed, Scopus, Embase, BVS and Web of Science, and the findings will be managed with the support of Rayyan software. Quantitative and qualitative studies, review articles, dissertations, theses, clinical guidelines and therapeutic protocols on the subject will be included, including gray literature. The total number of sources of evidence found and selected will be described. Through a narrative, the decision-making process of the inclusion of the studies will be detailed. The main findings must be described in line with the objective and the results related to the research question.

Plasma Calcium Level and C-Reactive Protein Albumin Ratio Affect Severe Bleeding After Coronary Artery Bypass Grafting

ABSTRACT Objective: In this study, we aimed to determine whether plasma calcium level and C-reactive protein albumin ratio (CAR) as well as other demographic and hematological markers are related in predicting severe bleeding after coronary artery bypass grafting (CABG). Methods: A total of 227 adult patients who underwent CABG at our hospital between December 2021 and June 2022 were prospectively studied. Total amount of chest tube drainage was evaluated within the first 24 hours postoperatively or until the patient was re-explored for bleeding. The patients were divided into two groups - Group 1, patients with low amount of bleeding (n=174), and Group 2, patients with severe bleeding (n=53). Univariate and multivariate regression analyzes were performed to determine independent parameters related to severe bleeding within the first 24 hours after surgery. Results: When the groups were compared in terms of demographic, clinical, and preoperative blood parameters; cardiopulmonary bypass time and serum C-reactive protein (CRP) levels were found to be significantly higher in Group 2 compared to the low bleeding group. In addition, lymphocytes, hemoglobin, calcium, albumin, and CAR were found to be significantly lower in Group 2. In multivariate analysis, calcium, albumin, CRP, and CAR were found to be independent predictors of significant association with excessive bleeding. A cut-off value of 8.7 (94.3% sensitivity and 94.8% specificity) for calcium and 0.155 (75.4% sensitivity and 80.4% specificity) for CAR predicted excessive bleeding. Conclusion: Plasma calcium level, CRP, albumin, and CAR can be used to predict severe bleeding after CABG.

Application effects of thoracoscopic resection of a pulmonary bulla without tube thoracostomy / 中国基层医药

Objective:To investigate the application effects of thoracoscopic resection of a pulmonary bulla without tube thoracostomy.Methods:A total of 60 patients who underwent thoracoscopic resection of a pulmonary bulla from January 2019 to January 2021 in Urumqi Youai Hospital were included in this study. They were randomly divided into an observation group and a control group ( n = 30/group). Tube thoracostomy was performed in the control group but not in the observation group. Oxygenation index measured at 24 hours, pain score measured at 24, 48 and 72 hours after surgery, complications, hospital stay, and total hospitalization expense were compared between the two groups. Results:There was no significant significance in oxygenation index measured at 24 hours between the two groups ( P > 0.05). At 24, 48 and 72 hours after surgery, pain score in the observation group was (2.6 ± 1.2) points, (1.5 ± 0.8) points, and (0.9 ± 1.1) points, respectively, which were significantly lower than (4.5 ± 1.4) points, (3.8 ± 1.5) points, (2.8 ± 1.7) points in the control group ( t = 1.34, 1.13, 0.92, all P < 0.05). The total incidences of postoperative pleural effusion and complications in the observation group were 3.3% (1/30) and 20.0% (6/30), respectively, which were significantly lower than 26.7% (8/30) and 46.7% (14/30) in the control group ( χ2 = 6.40, 4.25, both P < 0.05). The postoperative hospitalization time and total hospitalization expense in the observation group were (3.4 ± 0.8) days and (1.1 ± 0.3) × 10 000 yuan, respectively, which were significantly shorter or less than (6.5 ± 1.4) days and (1.4 ± 0.5) × 10 000 yuan in the control group ( t = 10.22, -1.88, both P < 0.05). Conclusion:Thoracoscopic resection of a pulmonary bulla without tube thoracostomy is feasible and safe, which has a certain promotion value.

An observational simulation-based study of the accuracy of intercostal drain placement and factors influencing placement.

Introduction: South Africa's significant burden of trauma and respiratory disease requires the regular need for intercostal drain (ICD) insertion. ICD misplacement is associated with significant complications. The aim of this study was to assess ICD insertion site accuracy and the factors affecting accuracy by Emergency Department doctors. Methods: This was a prospective, observational simulation-based study. Prior to participant admission, pertinent thoracic structures were marked on two simulated patients using an invisible marker which could only be seen using ultraviolet light. One by one, study participants were then asked to place a sticker on each side of each patient's chest to indicate where they would insert an ICD. Sticker placements were photographed under ultraviolet light. Placement sites were compared according to the most appropriate and accurate position for insertion (within the area superior to the 6th rib, posterior to pectoralis major and 1cm anterior to the mid-axillary line) as well as the British Thoracic Society's 'triangle of safety'. Comparisons of accuracy were made between participant rank (junior vs senior doctor), participant experience, simulated patient BMI category and placement side. Results: Insertion site was accurate in 47% of placements and within the 'triangle of safety' in 51% of placements. Improved accuracy was associated with greater participant experience (61% vs. 37%, p<0.01), and left-sided chest placement (54% vs 40%, p = 0.02). No difference was found when comparing simulated patient BMI category (low vs high, 43% vs 51%, p=0.18) or participant rank (junior vs senior, 41% vs 51%, p=0.10). Conclusion: Overall accuracy of ICD insertion site was low, and appropriate accuracy was only associated with greater participant experience and left sided placement. Further studies to determine methods to improve ICD placement accuracy are needed.

Role of Interventional Radiology in the Management of Non-aortic Thoracic Trauma.

Trauma remains a leading cause of death for all age groups, and nearly two-thirds of these individuals suffer thoracic trauma. Due to the various types of injuries, including vascular and nonvascular, interventional radiology plays a major role in the acute and chronic management of the thoracic trauma patient. Interventional radiologists are critical members in the multidisciplinary team focusing on treatment of the patient with thoracic injury. Through case presentations, this article will review the role of interventional radiology in the management of trauma patients suffering thoracic injuries.

The relationship between chest tube position in the thoracic cavity and treatment failure in patients with pleural infection: a retrospective cohort study.

BACKGROUND: Pleural infection is an infection of the pleural space that is usually treated with antibiotics and source control. Chest tube insertion is the most popular and widely used drainage technique. We typically attempt to place the tube at the bottom of the thoracic cavity to consider the effects of gravity; however, the effectiveness of this practice is not well-defined. Therefore, we aimed to examine whether the position of the tip of the thoracic tube affects treatment failure in patients with pleural infection. METHODS: In this retrospective observational study, patients with pleural infection who underwent thoracic tube insertion were divided into two groups: those with the tip of the tube positioned below the 10th thoracic vertebra at the level of the diaphragm (lower position group) and those with the tip placed above the 9th thoracic vertebra (upper position group). We compared whether the position of the tube tip affected treatment failure. Stabilized inverse probability treatment weights (SIPTW) were used to balance the baseline characteristics between the groups. Treatment failure showed a composite outcome of hospital death, referral to surgeons for surgery, and additional chest tube insertion. RESULTS: Among the 87 patients, 41 and 46 patients were in the lower and upper groups, respectively. No significant difference was observed in the composite outcomes between the groups (46.3% vs. 54.3%, P = 0.596). There was also no significant difference in the composite outcome between both groups after adjusting for SIPTW (52.3% vs. 68.8%, P = 0.286). CONCLUSIONS: There were no significant differences in the treatment failure in this study addressing pleural infection treatment, in which the drain tip position was stratified by the 9th and 10th thoracic vertebrae. The position of the tip of the thoracic tube may not be important for pleural infection treatment providing that it is in the thoracic cavity. Trial registration The participants were registered retrospectively.

Coaxial Drainage versus Standard Chest Tube after Pulmonary Lobectomy: A Randomized Controlled Study.

Chest tubes are routinely inserted after thoracic surgery procedures in different sizes and numbers. The aim of this study is to assess the efficacy of Smart Drain Coaxial drainage compared with two standard chest tubes in patients undergoing thoracotomy for pulmonary lobectomy. Ninety-eight patients (57 males and 41 females, mean age 68.3 ± 7.4 years) with lung cancer undergoing open pulmonary lobectomy were randomized in two groups: 50 received one upper 28-Fr and one lower 32-Fr standard chest tube (ST group) and 48 received one 28-Fr Smart Drain Coaxial tube (SDC group). Hospitalization, quantity of fluid output, air leaks, radiograph findings, pain control and costs were assessed. SDC group showed shorter hospitalization (7.3 vs. 6.1 days, p = 0.02), lower pain in postoperative day-1 (p = 0.02) and a lower use of analgesic drugs (p = 0.04). Pleural effusion drainage was lower in SDC group in the first postoperative day (median 400.0 ± 200.0 mL vs. 450.0 ± 193.8 mL, p = 0.04) and as a mean of first three PODs (median 325.0 ± 137.5 mL vs. 362.5 ± 96.7 mL, p = 0.01). No difference in terms of fluid retention, residual pleural space, subcutaneous emphysema and complications after chest tubes removal was found. In conclusion, Smart Drain Coaxial chest tube seems a feasible option after thoracotomy for pulmonary lobectomy. The SDC group showed a shorter hospitalization and decreased analgesic drugs use and, thus, a reduction of costs.

Safety and Efficacy of Indomethacin for Reducing Chest Tube Duration After Coronary Artery Bypass Grafting Surgery.

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) contain a boxed warning for use in coronary artery bypass graft (CABG) surgery due to increased risk of thrombotic events, but recent research has challenged the assumption that these risks are a class effect. One anecdotal indication for NSAIDs in CABG is reducing chest tube output. Objective: The primary objective of this retrospective study was to determine whether indomethacin was associated with reduced duration of chest tube insertion after CABG surgery, defined as total chest tube duration in controls versus duration of chest tube insertion after the first dose of indomethacin in the treatment group. Secondary objectives were comparisons of daily reductions in chest tube output volume, length of stay, and safety between groups. Methods: In this retrospective, single-center case-control review, adult patients who received indomethacin after CABG were matched 1:1 to control patients based on age, sex, concomitant valve surgery, and, when possible, diabetes status. Results: Thirty-two patients were included. The mean age was 56 years and 75% were men. The primary outcome measure was 94 hours among control patients and 82.8 hours among indomethacin patients (P = 0.041). Insignificant mean reductions in daily chest tube output were observed prior to and after indomethacin initiation (38.7 vs 87.7 mL/day, P > 0.05). Conclusion: In this small, single-center study, indomethacin appeared safe and possibly effective for reducing chest tube duration after CABG surgery. Future large, prospective, randomized studies should be conducted to confirm the results.

The effect of slow deep breathing relaxation exercise on pain levels during and post chest tube removal after coronary artery bypass graft surgery.

Objectives: This study aimed to evaluate the effectiveness of slow deep breathing relaxation exercise (SDBRE) in reducing patients' pain levels during chest tube removal (CTR) post coronary artery bypass grafting (CABG) surgery. Methods: In 2019, fifty post-CABG patients were conveniently selected from a cardiac intensive care unit in Jordan's major referral heart institute. The patients were randomly assigned to either an intervention group or a control group. A total of 25 patients were assigned into the experimental group who received slow deep breathing relaxation Exercise (SDBRE) alongside the conventional care before CTR. The remaining 25 patients constituted the control group (50%) that had CTR following conventional care. The Visual Analogue Scale (VAS) was used to measure the participants' pain levels during three phases: before CTR (Time 1), 5-min post CTR (Time 2), and 15-min post CTR (Time 2) to compare the intervention effect between the two groups. Results: The data analysis findings for the control and intervention group of patients showed that there was a statistically significant decline in their pain level across time for both groups (H = 32.71, P < 0.01; H = 47.23, P < 0.01) respectively. The intervention group had significantly lower pain levels than the control group at Time 2 (3.50 [1.20, 5.30] vs. 7.90 [7.00, 9.00], P < 0.01) and Time 3 (0.00 [0.00, 1.30] vs. 3.60 [2.40, 4.10] P < 0.01). Conclusions: Using SDBRE during CTR is an effective technique for reducing pain which can minimize the need for analgesics and their associated adverse effects.

Impact of Peer-Assisted Learning in Chest Tube Insertion Education on Surgical Residents.

Objective: To investigate the impact of peer-assisted learning (PAL) in chest tube insertion education on surgical residents. Methods: This study is a quasi-experimental study conducted on thirty general surgeon residents enrolled in the PAL program. They were divided into two learner groups (A and B) based on the period of residency start. Group A and B had six and one months of general surgery residency experience, respectively. All participants received adequate training for chest tube insertion by a recently graduated general surgeon. Chest tubes insertion skill was assessed using the tool for assessing chest tube insertion competency (TACTIC) test. Results: Post-TACTIC test score was significantly higher (p=0.001) than Pre-TACTIC test score in both groups. However, a comparison of mean Pre-TACTIC test scores and mean Post-TACTIC test scores between group A and group B showed that PAL effectiveness in group A was significantly higher (p=0.001) than group B. Conclusion: There was a positive relationship between the PAL program and the improvement of chest tube insertion technical skills in surgical residents. Based on our findings and similar studies, it can be concluded that the PAL program can increase the chest tube insertion skill of surgical residents.

Use of a Compact, Lightweight X-ray Unit to Reduce the Risk of Five Invasive Procedures in the Emergency Room.

BACKGROUND: Many invasive procedures performed in the emergency room (ER) have potential risks and complications. Because of their limitations, in particular size, portable X-ray devices are generally not used during such procedures. However, miniaturized units enable physicians to obtain X-ray images without assistance. METHODS: We developed a safe, compact, and lightweight X-ray unit that was used during five invasive procedures in the ER. In all procedures, a chest X-ray image was obtained, to confirm the utility of the unit. RESULTS: Case 1 (central venous catheter placement): After needle and guidewire insertion and catheter placement, the location of the catheter could be confirmed. Case 2 (chest tube insertion): During insertion of a chest tube into the pleural space, the tip of the thoracic tube was confirmed to be at the correct location. Case 3 (percutaneous tracheostomy or cricothyroidotomy): After needle and guidewire insertion, the guidewire was visualized in the right main bronchus and was inserted into the trachea. Case 4 (resuscitative endovascular aortic balloon of the aorta): The captured image revealed that the catheter was located in zone I before balloon inflation. Case 5 (Sengstaken-Blakemore tube): The image revealed that the balloon was located in the stomach. CONCLUSIONS: The portable X-ray unit improved medical safety during invasive procedures frequently performed in the ER.