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Open Access

Tube thoracostomy during the COVID-19 pandemic: guidance and recommendations from the AAST Acute Care Surgery and Critical Care Committees

Fredric M Pieracci, Clay Cothren Burlew, David Spain, David H Livingston, Eileen M Bulger, Kimberly A Davis, Christopher Michetti
DOI: 10.1136/tsaco-2020-000498 Published 30 April 2020
Fredric M Pieracci
1 Department of Surgery, Denver Health, Denver, Colorado, USA
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Clay Cothren Burlew
1 Department of Surgery, Denver Health, Denver, Colorado, USA
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David Spain
2 Department of Surgery, Stanford University, Stanford, California, USA
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David H Livingston
3 Department of Surgery, Rutgers, New Brunswick, New Jersey, USA
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Eileen M Bulger
4 Department of Surgery, University of Washington, Seattle, Washington, USA
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Kimberly A Davis
5 Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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Christopher Michetti
6 Department of Surgery, Inova Fairfax Medical Center, Falls Church, Virginia, USA
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    Figure 1

    Denver Health Medical Center algorithm for thoracic surgery/procedures during COVID-19. EDT, emergency department thoracotomy; PAPR, powered air purifying respirator; PPE, personal protective equipment; PTX/HTX, pneumothorax/hemothorax.

  • Figure 2
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    Figure 2

    Bleach may be added to the water seal chamber of the drainage system (orange arrow) instead of water alone.

  • Figure 3
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    Figure 3

    In line viral filter applied to chest tube drainage system while on suction. Pictured is the BILF150 Multi-use in-line Filter (Buffalo Filter LLC, Lancaster, New York, USA) with two sections of additional suction tubing attached.

  • Figure 4
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    Figure 4

    Gravity bag-based viral filter (pictured is the LaproShield Plus, Pall Medical, Port Washington, New York, USA) (A); attached to drainage system suction port while on water seal (B). Note that the lure lock has been cut-off so that the filter tubing may fit into the suction port of the drainage system.

  • Figure 5
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    Figure 5

    Cable tie and gun (A); two cable ties allow easy visualization of the connection with complete assurance that the connection will not be dislodged (B).

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Tube thoracostomy during the COVID-19 pandemic: guidance and recommendations from the AAST Acute Care Surgery and Critical Care Committees
Fredric M Pieracci, Clay Cothren Burlew, David Spain, David H Livingston, Eileen M Bulger, Kimberly A Davis, Christopher Michetti
Trauma Surg Acute Care Open Apr 2020, 5 (1) e000498; DOI: 10.1136/tsaco-2020-000498

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Tube thoracostomy during the COVID-19 pandemic: guidance and recommendations from the AAST Acute Care Surgery and Critical Care Committees
Fredric M Pieracci, Clay Cothren Burlew, David Spain, David H Livingston, Eileen M Bulger, Kimberly A Davis, Christopher Michetti
Trauma Surg Acute Care Open Apr 2020, 5 (1) e000498; DOI: 10.1136/tsaco-2020-000498
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Tube thoracostomy during the COVID-19 pandemic: guidance and recommendations from the AAST Acute Care Surgery and Critical Care Committees
Fredric M Pieracci, Clay Cothren Burlew, David Spain, David H Livingston, Eileen M Bulger, Kimberly A Davis, Christopher Michetti
Trauma Surgery & Acute Care Open Apr 2020, 5 (1) e000498; DOI: 10.1136/tsaco-2020-000498
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  • Article
    • Abstract
    • Background
    • Creation of a thoracic procedure team
    • Creation of an institutional algorithm for thoracic procedures
    • Creation of an equipment bag (‘go bag’) for tube thoracostomy
    • Footnotes
    • References
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