A chest tube is a flexible catheter frequently used in pre/post-operative setting, which is inserted into the chest cavity to evacuate air (pneumothorax) or fluids (blood, effusion, chyle or pus). There are more than one million chest tubes placed annually in the United States (1) and many more worldwide (it is the most common intervention in thoracic trauma).
The current designs of chest tubes are far from ideal. The most common complication is clogging/blockage of the catheter by thrombus/debris which can cause major complications (drainage stasis, infections, non-functioning/malfunctioning). In a study of 234 chest tubes in patients undergoing cardiac surgeries, there was a 36% clogging rate and non-functional tubes were associated with a higher risk of potentially lethal consequences (2). Interestingly, more than 80% of the clogging in the chest tube was seen in the internal portion of the tube (the invisible intra-thoracic portion), which makes the diagnosis of this complication by bedside visualization impossible (2). Clogging of the tube can become life threatening in cases where bleeding in the chest will go undiagnosed or blood accumulates around the heart and lung. In a survey that included North American cardiothoracic surgeons and specialty nurses, 100% of the responders confirmed encountering problems with clogged catheters and 87% reported adverse patient outcomes (3). More than 50% of the participants confirmed not being satisfied with currently available tubes (3).
Our chest tube design consists of:
a: A flexible plastic tube which is inserted into the chest cavity and has side holes. The open end of the chest tube enables the passage of the camera (equipped with the suction-irrigator and biopsy probe). This camera apparatus allows the physician to unclog the tube, reposition it, visualize the inside of the chest cavity, deliver drugs and contrast, perform interventional radiology procedures and pleurodesis, access the mediastinum, and obtain microbiology and histopathology specimens from the lung, pleura, and mediastinum.
b: A three-way valve which is attached to the outer side of the catheter (we have a provisional patent on this valve [EFS #18025431]) and allows easier switching operation of branch-tubes. The valve comprises of a chamber with a nearly spherical inner surface, branch-tubes extending from it, and a rod-shaped operating part with a guide hole linking the inner surface of the chamber to the outside.
c: A thoracoscopy device which is purposefully designed to work with this chest tube. It is sterilizable and reusable.
Having a price comparable with the currently available chest tubes, this device is targeted for use by surgeons, internists, pulmonologists, interventional radiologists, and other physicians. Our design aims to make chest tubes more efficient, safe, durable, and salvageable from clogging. This would spare patients from multiple procedures, reduce the risk of infection and operation time, and make the detection of the tube malfunction and catheter tip position change easier. The lumen of our chest tube could be used as a port of entry when performing the video-assisted thoracoscopy surgery, which would spare the patient from further incisions.