Department of Bioengineering
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A chest tube thoracostomy is a procedure in which a tube is inserted into the pleural space of a patient and suction is applied to relieve pressure on the lungs. The pleural space maintains negative pressure to allow the lungs to expand, so any pressure in this space caused by air or fluid buildup means the lung collapses and the patient cannot breathe properly. Approximately 1 million chest tubes are placed per year in the United States and the market value of thoracic drainage devices was estimated at $615 million in 2018. Problems often occur when an inexperienced surgeon or first responder is tasked with placing a chest tube. Even an experienced surgeon can take longer to perform the procedure than necessary. The procedure often inflicts unnecessary damage to the patient’s tissue around the insertion point, or exacerbates the injury by damaging the lung, diaphragm, or intercostal vasculature. Other issues arise when a first responder, such as a paramedic, believes that a thoracostomy will take too long and opts instead for needle decompression which has a failure rate upwards of 65%.
The team developed a device called the Chest Wedge that can rapidly and safely insert a chest tube into a suffering patient. The device is shaped to allow it to be easily pushed through the intercostal muscle to reach the pleural space. It also has safety retainers that are designed to deploy once the pleural space has been penetrated to prevent pushing the device too deeply and damaging the lung. The safety retainers are situated inside the device to prevent them from damaging intercostal vasculature or nerves, which is a concern when penetrating the space between a patient’s ribs. The device is designed to allow a chest tube to be inserted after which the device can be removed from the patient, leaving only the tube in place. The team also developed a Chest Guide to help the user quickly locate the proper insertion point. Taken together these devices will improve the time required for chest tube placement. With minimal training it will be usable not only by surgeons but eventually by paramedics, flight for life responders, and field medics. This will significantly improve outcomes as trauma patients either arrive at the ER with a chest tube in place or the surgeon can place one very quickly.