AHRQ creates DVD on chest tube insertion

The Agency for Research and Healthcare Quality (AHRQ) has a DVD available on the proper insertion of chest tubes. The 11-minute DVD uses video footage of 50 chest tube insertion procedures taken at medical centers in the Baltimore, MD, area.

"Chest tubes, unlike other invasive catheters, are never replaced," explains Colin Mackenzie, MD, Professor of Anesthesiology at the University of Maryland, who along with his colleagues observed the procedures and developed the DVD. "We saw during our observations that there were problems with the technique of tube insertion, and research shows this may be the cause of a number of infections."

The preventive measures demonstrated in the DVD are represented by the mnemonic device UWET, which stands for:

  • Universal precautions: These, says Mackenzie, are (or should be) "standard operating procedure" when any surgery is being done – i.e., sterile gloves, gown, cap, and mask. "Still," he says, "We found that in emergencies people were sometimes not doing that."
  • Wider skin preparation: "We found that people would make small preparations of skin around the area in which they wanted a chest tube and then contaminate the skin or themselves by touching areas outside of what was prepped," Mackenzie shares.
  • Extensive draping: This is a similar problem, says Mackenzie. If the area is too small, instruments may go beyond the drapes and become contaminated.
  • Tray positioning: "We found that because of the nature of trauma, especially its emergency aspects, sometimes as many as three different procedures were being done from the same tray," Mackenzie notes. "We also noted two [surgical] knife cuts and one needle stick in the 50 procedures." He and his colleagues recommend using a separate tray for each procedure.

Copies of the DVD can be ordered from the AHRQ Publications Clearinghouse by calling (800) 358-9295, or by e-mailing: ahrqpubs@ahrq.hhs.gov.