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12/08/2015

Drainer un thorax sans drain

Improvised Chest Tube Drain for Decompression of an Acute Tension Pneumothorax

Vinson ED Mil Med. 2004 May;169(5):403-5.

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Décomprimer un thorax est indispensable en cas de pneumothorax suffocant.  Si la décompression à l'aiguille est souvent présentée comme la technique de référence, encore faut il que sa réalisation soit faite par voie latérale avec un cathéter de calibre et longueur suffisant. Néanmoins cette technique est sujette à échec. La thoracostomie au doigt est la méthode la plus efficiente et la moins dangereuse. La justification de la pose d'un drain thoracique est moins claire: durée de transport conséquent, reconstitution du pneumothorax. Encore faut il avoir un drain.Si le cathéter du minitrach percut 2 peut être utilisé, c'est aussi le cas d'une ligne et d'une poche de perfusion qui semblent être une alternative à ne pas méconnaitre.

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A case of a woman presenting with an acute tension pneumothorax during a Navy humanitarian mission in East Timor is presented. The patient was treated at a local rural clinic run by our medical team. Prompt insertion of a chest tube saved the woman’s life; however, there were no chest tube drains available. A field chest tube drain constructed out of an IV bag, a sterile water bottle, and tubing provided an adequate underwater seal and drain. Because of the remote location and limited resources, standard prehospital chest tube management had to be modified. A brief review of simple and tension pneumothoraces and management along with a description of the field chest tube drain is presented

drainage thorax

"The equipment needed includes a 24-French chest tube, a 100-mL NS IV bag, a 1,000-mL plastic sterile saline bottle, and two standard primary IV tube sets. The sterile water bottle is prepared by first emptying the contents. Next, two holes should be cut large enough to fit the surgical tubing, one in the cap, and one in the top of the bottle. The IV bag and primary IV tubing should be attached and the tube should be cut between the filter and reservoir. This end is left open for a vent. The other outlet port should be cut open to allow one end of a surgical tube to be inserted. The chest tube is then attached to the plastic spike of the other IV tubing. The other end of the tube is placed into the sterile water bottle through the hole in the cap. The surgical tube from the IV bag outlet port should be attached to the sterile water bottle through the hole in the side. The surgical tubing from the sterile water bag needs to be long enough to reach the top of the IV bag. To operate the system, the IV bag should be inverted to keep the underwater seal to the sterile water bottle. This allows the long tube to stay underwater while the short tube vents air out of the bag. To dispose of any accumulated fluid, the chest tube is first clamped near the patient. The water bottle can then be removed and emptied while the cap remains attached to the chest tube. It is then a simple matter to reattach the bottle and unclamp the chest tube"

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