Abstract
Background: During thoracoscopy, chest tubes can be placed via thoracoscopy ports with relative ease. In contrast, chest tube placement in an awake child can be a traumatic event both for the operator as well as the patient. This report describes a method of tube thoracostomy utilizing a minimally invasive technique at the bedside.
Patients and Methods: After performing thoracoscopic chest tube placement on multiple patients under general anesthesia, a similar technique was used at the bedside utilizing the Step trocar system for tube thoracostomy (STEP-TT). Thirty children and infants from 1 month to 15 years of age required thoracostomy; 8 pneumothoraces, 15 pleural effusions, 3 traumatic hemopneumothoraces, 2 chylothoraces, one pneumatocele, and one arrest resuscitation. After administration of sedation and local anesthetic, a small incision was made. The Veress needle and radially expandable sleeve were advanced into the thoracic cavity, followed by dilation with a cannula. A chest tube was placed via the port.
Results: All chest tubes were successfully placed in good position as documented by chest radiograph and 29/30 were initially therapeutic. Procedural time was approximately 20 minutes.
Conclusion: The STEP-TT can be performed at the bedside and is safe and effective in children of all ages. This minimally invasive technique permits faster as well as more precise tube thoracostomy placement and is better tolerated by patients, with little morbidity.
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