H.16 Improving positioning of chest tubes for trauma

1. Clinical Need
1. Patients who have undergone blunt or penetrating trauma to the chest often have hemothorax (blood in the chest cavity) or pneumothorax (air in the chest cavity) that needs to be urgently evacuated. Majority of the time, chest tubes (flexible tubes made out of PVC) are placed at the bedside through the patient’s chest wall without the ability to have any visualization of the inner chest cavity, which can lead to tube malposition or suboptimal tube positioning. This can cause ineffective drainage of blood or air, and at worst, an injury to chest wall or lungs or heart, and necessitate a repeat chest tube placement or bigger surgical procedure. 
2. Current technologies available
1. Needle-based percutaneous thoracostomy tubes
1. – Technology: allows a user to thread a wire into a cavity then use Seldinger technique to upsize the tract to insert a smaller chest tube through smaller incision
2. – Why insufficient: still a very blind procedure, can accidentally thread wire into the soft tissue, lung, or heart by mistake
2. Digital drainage devices
1. – Technology: can accurate measure the amount of fluid or air that the chest tube is evacuating at any time
2. – Why insufficient: does not help at all the positioning of the chest tube itself
3. Chest tube irrigation devices
1. – Technology: allows user to flush chest tube and chest cavity with fluid in attempt to irrigate the cavity to clean out any retained blood or material
2. – Why insufficient: minimal adoption/use in trauma as of today, requires additional setup, still unable to visualize where the chest tube is placed prior to irrigation
4. Chest tube self clearance technology
1. – Technology: newer chest tubes that are double lumen in nature allow the device to “self-clear” itself of any clogged materials regularly to ensure patency of drainage tube
2. – Why insufficient: better patency but still cannot ensure the chest tube is positioned optimally in the chest
3. Perceived impact of addressing the problem
1. If we are able to develop a solution where the provider/user can visualize the path of the chest tube device, he/she can visually see where to place the tube in the chest cavity, ensure optimal positioning for drainage, and minimize the risk of injury to organs or soft tissue