Use of the iTClamp versus standard suturing techniques for securing chest tubes: A randomized controlled cadaver study
Jessica Mckee 4, 5, Ian Mckee 2, Melanie Bouclin 3, Chad G. Ball 4, 5, 9, Paul McBeth 4, 5, 6, 9, Derek J. Roberts 5, 7, Ian Atkinson 1, Dennis Filips 1, Andrew W. Kirkpatrick 4, 5, 6, 8, 9
1Innovative Trauma Care, Clinical Department, Edmonton, AB, Canada
2City of Edmonton, Fire Department, Edmonton, AB, Canada
3North Edmonton Veterinary Emergency, Emergency Department, Edmonton, AB, Canada
4Regional Trauma Services, University of Calgary, Calgary, AB, Canada
5Department of Surgery, University of Calgary, Calgary, AB, Canada
6Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
7Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
8Canadian Forces Health Services, Ottawa, ON, Canada
9Alberta Health Services, Foothills Medical Centre, Calgary, AB, Canada
Keywords: Chest tube, Tube thoracostomy, Securing chest tubes
Abstract
Objectives: Tube thoracostomy (TT) is a common yet potentially life-saving trauma procedure. After successful placement however, securing a TT through suturing is a skillset that requires practice, risking that the TT may become dislodged during prehospital transport. The purpose of this study was to examine if the iTClamp was a simpler technique with equivalent effectiveness for securing TTs.
Materials and methods: In a cadaver model, a 1.5 inch incision was utilized along the upper border of the rib below the 5th intercostal space at the anterior axillary line. TTs (sizes 28Fr, 32Fr, 36Fr and 40Fr) were inserted and secured with both suturing and iTClamp techniques according to the preset randomization. TT were then functionally tested for positive and negative pressure as well as the force required to remove the TT (pull test-up to 5 lbs). Time to secure the TT was also recorded.
Results: When sutured is placed by a trained surgeon, the sutures and iTClamp were functionally equivalent for holding a positive and negative pressure. Mean pull force for both sutures and iTClamp exceeded the 5 lb threshold; there was no significant difference between the groups. Securing the TT with the iTClamp was significantly faster (p < 0.0001) with the iTClamp having a mean application time of 37.0 ± 22.8 s and using a suture had a man application time of 96.3 ± 29.0 s.
Conclusion: The iTClamp was effective in securing TTs. The main benefit to the iTClamp is that minimal skill is required to adequately secure a TT to ensure that it does not become dislodged during transport to a trauma center.