IP Requirement: MUSC IP
Experience Requirement:
– Mechanical Design
– Rapid Prototyping
Problem Description
Chest tube placement is a routine procedure performed in the ED, ICU, and floor for evacuation of pneumothorax, hemothorax, pleural effusions, and empyema, among other indications. They are placed by emergency medicine physicians, general surgeons, thoracic surgeons, pulmonologists, and critical care providers. It is estimated that at least 100k chest tubes are placed annually for traumatic injuries alone. While chest tubes can be placed quickly and effectively by experienced providers, the national data and this surgery resident’s personal experience suggest an unacceptably high complication rate. 1 in 5 chest tubes is associated with a complication. Complications vary in their severity, from minor complications (e.g. chest tube tunnels in soft tissue and never makes it into the thoracic cavity) to major complications that require emergent surgery (e.g. tube placement into the liver, spleen, heart, pulmonary vasculature, etc). Overall, the data suggest that 15% of complications are related to insertion and 50% are related to position.
There are two well accepted techniques for chest tube placement: open and minimally invasive percutaneous technique. The open technique requires are large incision, blunt spreading of muscle and ribs, and direct placement of a large inflexible chest tube in the thoracic cavity using the finger to guide it in the correct direction. The minimally invasive technique requires insertion of a needle into the thoracic cavity, the introduction of a wire through the needle, the removal of the needle, and the exchange of a series of dilators over the wire until the tract is large enough for a chest tube. In both cases, chest tube position is confirmed with Xray imaging post procedure. The complications associated with these methods introduce unnecessary harm to the patient when the chest tube is placed incorrectly, cost for the institution with additional procedures and imaging, and time to the provider placing the chest tube. There exists an opportunity to improve the process of chest tube placement to reduce their complication rate and improve outcomes.
