Video

Good tutorial aside from the hitch portion. I wish you would have described the step more in depth. Seems like a simple move, but I cannot seem to pass it.

Does anybody still have the slides or notes ?

Wrong clamping, the surgical clamp is beyond the chest tube, at risk of organ injury. It should be behind the tube tip

Thank you for this wonderful explanation

I got 5 chest tubes about 8 years ago, still hurts. The whole process is a nightmare, still have dreams of getting them pulled out.

What does he say at minute 13? “*word* the line when you insert it”

Over decades, I've placed thousands of central and other large-vessel access catheters...all without US. Things change and that's usually good, esp. for subclavian puncture. There is often inadequate appreciation of the variations in position of the vessels when insufficient thought is given to the pt's individual habitus. Also, when the lungs are hyperinflated the cupula of the lung can almost envelope the vessels as it is forced superiorally. This adds greatly to the danger. Remember, too, that the thoracic duct is on the left. No one wants to have to repair that. I am an annoying advocate of placing a strong cidal barrier at the catheter puncture site and I favor betadine ointment. These catheters are significant sources of hospital-acquired infections that can be deadly. I changed each dressing daily and reapplied betadine. This was best for the pt. and reinforced the importance to the staff. Unfortunately it doesn't eliminate the risk caused by staff when they replace lines and contaminate Luer locks.

I honestly don't know how many of these I have done...many hundreds. I've never used US and never had any complications or needed to change sides. It's that easy. These days I wonder how much money the hospitals add to the pt's. charges when US is used. It's probably a shocking amount. Even in active situations, one should always prep the skin. It can even be done by someone else while the operator is gloving. Intravascular catheters are major sources of often-disastrous hospital-acquired infections and care must be taken to avoid them. Very good video. Hopefully it will help many as their training progresses.

Informative and well-presented. I would add a few comments that have helped me over the years and hopefully helped the hundreds of pts. whom I resuscitated: There is no place for chaos during resuscitation. In fact, there is no place for chaos period. There is rarely a reason to raise one's voice. Everyone must understand who is in charge and directing the effort. That person makes certain that nothing is overlooked and that all of the data being generated are assimilated. I think it is best if he/she is not actively participating in the mechanics of the effort unless needed to do something requiring his unique expertise. All those who are not actively participating in the effort should leave the room. If a pt. is at all salvageable, he should be saved. Don't give up prematurely. My own two longest resuscitations in which both pts. left the hospital without sequelae were over 6 hrs. each in duration.

Nice doll with a GCS of 15!

Do you concur?

general thoracic surgery resident. My takes: 1. decubitus position with roll under side spreads intercostal spaces and moves away abdominal organs 2. Place a deferred/delayed suture for future easier and safer removal of drain. 3. Placing the drain with a clamp as a guide may damage intercostal space, Drains with mandrins are preferred 4. You can drain any coastal space in any line. You need to be sure if the disease (pus, air, effusion) is located there. Confirm with thoracocentesis via your local anestethic needle (aspirate the pleural cavity) 5. If draining fluids - guide your drain posteriorly and caudally if draining pneumothorax guide your drain anteriorly and apically 6. Remember about premedication with opioids (helps with pain but also dyspnea), be abundant with local anestethic. And personally, We hate those complex drainage systems, a simple single-chamber bottle is our way to go.

Dr. Franco should def. volunteer haha

Great overview! Waiting for more videos like that 👍

Thank you that was one of the best explanations of the creep method😊

This was very helpful. Thank you.

Excellent job going through basics and thorough enough to talk about the finer points of efficiency.

Great video!

I'm a student nurse. This helped tremendously in understanding chest tube insertion process. Thank you for this.

Hernia repair was one of the reasons I declined the offer of surgical residencies...twice.

Love it, Surgery Bro. As a practical matter, someone on the team must be in charge. This may mean assigning roles, observing, recording and being absolutely certain that nothing is being overlooked. He/she should not be distracted (or, if necessary, only minimally and briefly distracted) by active participation. Though resuscitation may seem chaotic, it must never be.

thank you sunshine!

As a chronic illness patient I think all doctors should experience a central line placement without the numbing medication. Maybe then they will stop trying to do this procedure on patients without numbing the area and telling the patient that “it shouldn’t hurt that bad”

As a chronic illness patient I think all doctors should experience a central line placement without the numbing medication. Maybe then they will stop trying to do this procedure on patients without numbing the area and telling the patient that “it shouldn’t hurt that bad”

Wtf.!!!!! Its never too late. Finally i got it here.

very easy to learn as explained

I had to have this done in ER & thought I was gonna die! They used a guide wire to put tube in & it crimped and they had to pull it back out! It honestly hurt like nothing I’d ever experienced. I screamed so loud & I have a high tolerance to pain. Had to go back a week later to my doctor & my lung had collapsed again(I believe this all happened due to getting Covid vaccine). Told my Dr. I couldn’t go through that again. This time they did it Completely different with not one second of pain. They did it in hospital this time.

Best video on central line

Very good video

What mesh was used ? How long does the mesh has been implant onto the abdominal area

Three brilliant and beautiful women. I’m on the transplant list (ESRF from PKD, currently on PD for two years) and I would be thrilled if any of these doctors would be my surgeon. Thank god for dedicated, intelligent people like them.

Personally I prefer zipties to force the tubing onto the connector using a banding gun. I've had an instance where surgical staff didn't band the chest tube and the atrium connection came off the tube, exposing the pleural cavity to the atmosphere via the chest tube. IMO tape would simply come off too easily. But otherwise great video!

Can that procedures be done using radial or brachial artery?

Great Video Thanks for you

Anyone looking for assistance in India for kidney transplant surgery can reply will provide all needs😊

Thank you so much sir...

confirmation xray, yes!

Surgeon at Northwestern is hesitant to do surgery due to my renal vassels too calcified. What do I do?

Jan

Good stuff!

Brilliant description and plenty of gems in this illustration. Thank you!!

I read a lot of these comments. And it's obvious that no one had this procedure done on them, but, I did and at 1 point it was agony. It felt like a sharp knife went through my back and I literally screamed so loud. I passed out and them was given more feign. It was a nightmare and I will never ever go through it again. I had pneumonia and I got fluid from the pneumonia or so. I was told if I ever get fluid again. I'll probably die before. I'll go through that again. Or else demand that I be put to sleep? It wasn't too bad until the 2 got to the higher part of my back and lit. Erally I can't say it enough. It was like a dagger going to my back end. I have a high tolerance for pain, so I'm not exaggerating. This, this is a good procedure. In one way. Been another way. I believe people should be put to sleep. If there is sensitive or have Arthritis, let's say in their spine, which I have. I had a panic attack just watching this

Thank you

Solid video! ❤

This is really informative and extremely helpful to me. I am coming up to two years post anterior resection and reversal of an illeostomy. I think this confirms to me that I have long term LARS. Thank you for this :) It is nice to know it is not just me :)

Great video, a shoutout from egypt. Very good to have a surgeon's perspective on radiology.

And then ?

Very well put! 👏🏻 👏🏻

very helpful.Love from University of the west indies

Just getting ready for pgy1 love this