Article Text

PDF

Seldinger technique chest drains and complication rate
  1. Jon Argall, Senior Clinical Fellow in Emergency Medicine,
  2. Joel Desmond, RCS Research Fellow,
  3. K Mackway-Jones
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}man.ac.uk

    Abstract

    A short cut review was carried out to establish whether the seldinger “over the wire” technique is better than other techniques of pneumothorax drainage. Altogether 28 papers were found using the reported search, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

    Statistics from Altmetric.com

    Report by Jon Argall, Senior Clinical Fellow in Emergency MedicineChecked by Joel Desmond, RCS Research Fellow

    Clinical scenario

    A 30 year old man presents to the emergency department after a road traffic accident. On initial assessment you identify a haemothorax/pneumothorax on the left side of his chest; there are no signs of tension. You elect to place a chest drain and discover that you have a seldinger “over the wire” technique chest drain in front of you. You wonder whether this method of placement is better than any other at achieving successful management of the injury without complication.

    Three part question

    In [a patient requiring a chest drain after trauma] is [a seldinger “over the wire” technique better than other methods or chest drain placement] at [achieving pneumothorax resolution without complication]?

    Search strategy

    Medline 1966–12/02 using the OVID interface. [(exp chest tubes OR exp thoracostomy OR “chest drain$”.mp) AND (“seldinger”.mp OR “needle wire dilator”.mp OR “over wire”.mp OR “small bore”.mp OR pigtail.mp OR “pig tail”.mp)] LIMIT to human AND English.

    Search outcome

    Altogether 28 papers were found by the Medline search. No papers were directly relevant but three papers had some relevance to our clinical question. These are listed in table 1.

    Table 1

    Comment(s)

    There is no comparative work looking at the use of a seldinger technique for placement of chest drains in adult trauma patients. Of the papers that were found uncontrolled series reports document their comparatively safe use in adults and children in well controlled elective and intensive care settings. Complications such as recurrence of the pneumothorax, kinking of the drain do still occur as is seen in the open technique, but insertion complications or difficulties seem to be rare.

    CLINICAL BOTTOM LINE

    There is no evidence to show that a seldinger over the wire insertion technique is superior to traditional methods.

    Report by Jon Argall, Senior Clinical Fellow in Emergency MedicineChecked by Joel Desmond, RCS Research Fellow

    References

    View Abstract

    Request permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.