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.

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.