Cite this post as:
Scott Weingart, MD FCCM. Bougie-Guided Chest Tube. EMCrit Blog. Published on April 26, 2012. Accessed on October 2nd 2023. Available at [https://emcrit.org/emcrit/bougie-guided-chest-tube/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: April 26, 2012
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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I’ve tried this before. I’m not a fan. In setting of non traumatic, stable patient with pneumothorax that needs a tube, I think a pigtail is the best option and it’s easily placed no matter how obese. Avoids a lot of morbidity of bigger tube. For patients with history of prior hemo or pneumothorax, significant copd, cancer in the lungs/thorax. or basically any patient at risk for thoracic adhesions, I think this method makes iatrogenic injury to the lung more likely because you can’t sweep adhesions aside or assess the situation before putting the tube in. In very obese patients,… Read more »
My impression and the only way I would use this technique is AFTER putting the finger in and 360 sweep. Bougie would only be as a guide for the chest tube after feeling the bougie enter the cavity under your finger if I am understand what was relayed to me correctly.
If the finger goes in first, then that’s great! As long as your are darn sure your boogie is actually going into the thoracic cavity into a trajectory you like after you have assessed the situation with your finger.
Regarding the length of a boogie though, in an obese patient it wouldn’t be long enough potentially… and you don’t want to lose your boogie in the patient! One could use an ET tube exchanger which is significantly longer though.
to be honest, I am not convinced this adds much. In the surgical airway, you can get away with it because the anatomical distances are not so great. In the chest wall, if you are having problems, its better to make a bigger incision and dilate it with your finger. Also the Gordon Ewing case always makes me respect the potential for a blind passage of a plastic semi rigid thin tube to penetrate the lung, albeit it was spurting 15L per min of oxygen at the tip.
“crack of the scrotum popping”. How awful.
Agree – too much chance of a false passage I reckon. Unless it’s finger-bougie-chest tube…
On an aside, I have fiddled with the bougie-ETT tube alternative to formal chest tube in an animal lab with sheep…fairly robust, but I do wonder how comfortable it is for the patient.
Meanwhile, those Norse Gods of anaesthesia/ICU suggest that a central line may be appropriate for some PTXs
http://www.scancrit.com/2012/04/27/2937/
I prefer the Thal Quik chest tubes.
Interesting. If you watch thoracic surgeons put chest drains in they use the trocar, in a similar way to how we would use the needle in an IV cannula – insert just into the cavity but no further, point towards the apex and slide the drain over and in. It looks very slick, and it works well PROVIDED you have already made a track for it and are not using the trocar to make the hole. I have never found the technique of guiding the drain towards the apex using forceps very satisfactory, it just makes the hole enormous and… Read more »
How do you get a sterile bougie?
Jesse,
all disposable bougies come sterile
I was convinced to switch to the method that Chloella mentions by a CT surgeon during a trauma for all the reasons given. Incise-blunt dissect-release air/blood – finger sweep – trocar tip alongside – take finger out – advance tube. Elegant, safe, quick, small cut, no subcut emphysema. I
Trocars have long been removed from chest tubes in the States. They are rife with complications. If you folks are using them just as a guide ask yourself why they are extremely sharp. If they were intended to be used in the way you describe, they would have a beautifully rounded tip and there would be no problem with their use. Try the bougie instead, much safer guide.