A 40 year-old man presents with a traumatic hemopneumothorax. He weighs 400 pounds.
Chest tubes can sometimes be challenge, especially for those with extra redundant tissue to tunnel through before reaching the intrathoracic cavity. You want to avoid placing the chest tube mistakenly in the subcutaneous space. How can you ensure that your chest tube actually reaches the intrathoracic space?
Trick of the Trade:
Use a bougie as a "stylet" to guide your chest tube
Insert the thinner, longer, and semi-rigid bougie into the intrathoracic cavity. Confirm placement with your finger. Then slide the chest tube over it and remove the bougie. So elegantly simple and effective.
|Images courtesy of Dr. Graham Walker (Kaiser San Francisco)|
Thanks to the Twitter collective and Dr. Seth Trueger (@MDaware) for the tip! I believe the credit goes to Dr. Charles Maddow (UT Houston). Check out this Twitter thread and how this discussion came about. Another illustrative example of the power of social media.
Also see: Befriend the bougie from Life in the Fastlane