A Novel Thoracostomy Tube to Reduce Displacement and Bacterial Introduction

Abstract Traumatic injury is the leading cause of death in Americans less than 44 years old, accounting for more than 37 million emergency department visits and 2.6 million hospital admissions. 1 Of these patients, 7-18% of patients experiencing chest trauma will require a tube thoracostomy to manage either a pneumothorax or hemothorax secondary to their traumatic injury. 2, 3 However, 7-28% of sutured chest tubes are displaced, resulting in unnecessary repeat procedures, additional radiation exposure for chest radiographs, and additional risk of procedural complications. 4, 5 Improved design of the thoracostomy tube could reduce the rate of displacement and significantly improve quality of care for patients with thoracic trauma. Current thoracostomy tubes are subject to significant amounts of movement, due to the variable techniques in securing, and the low fidelity of securement devices. 6, 7, 8 Additionally, infection may occur in up to 18% of chest tube insertions either at the site of chest tube insertion, or within the thoracic cavity. 8, 9 This often occurs due to bacteria entering the chest cavity at the site of insertion with bacterial profiles consistent with epidermal flora and intestinal flora. 9 The duration of chest tubes is correlated with an increased risk of infection, thereby further associating the insertion site as a source of intra thoracic infection following thoracostomy tube placement. 10 Therefore, an improved design of thoracostomy tubes to reduce movement at the insertion site and protect the insertion site from continued seeding of pathogens may reduce infectious complications of chest tube placement. The specific placement location of chest tubes is contested. Dogmatic teachings educate trainees and practitioners to place apical chest tubes for pneumothorax and basilar chest tubes for hemothorax, effusion, or empyema evacuation. However, the initial location of chest tube placement does not predict the need for more invasive procedures in empyema, nor in hemothorax. 11, 12 Importantly, the chest tube sentinel hole needed to remain within the pleural cavity in order to remain effective.11 Therefore, a more standardized location of chest tube placement, with ensuring the sentinel hole is not displaced outside of the chest wall, may lead to improved hemothorax evacuation outcomes. While other investigators have developed novel techniques to reduce chest tube displacement rates in small bore, percutaneously placed thoracostomy tube. 13 Similar novel technology has not been investigated for the trauma patient, in a surgically placed chest tube. Additionally, efforts have been focused on reduced displacement, not standardization of placement and reduced movement of the tube after it is placed in the chest. Our proposal aims to develop a novel thoracostomy tube, featuring an internal balloon to reduce displacement and an external bumper to reduce movement of the tube within the chest wall.