• Journal of Korean Academy of Fundamentals of Nursing
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• v.9 no.1
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• pp.27-44
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• 2002

The main purpose of this study was to identify the effect of hand massage on pain and anxiety related to chest tube removal in patients with a lobectomy. The research design of this study was a nonequivalent control group non-synchronized design. Of the twenty nine adult subjects, fourteen were assigned to the experimental group and fifteen to the control group. The data were obtained over 3 months from a medical center in Seoul. The instruments used to assess trait state anxiety was the Spielberger Trait-State anxiety Inventory. For pain and psychological anxiety. The Visual Analogue Scale was used. Hiko analogue sphygmo-manometer(2001) was used to check blood pressure and pulse rate as indicators of physiological anxiety Subjects in the experimental group received hand massage for 5 minutes just before chest tube was removed, and subjects assigned to the control group did not receive hand massage. Data were analysed with $x^2$-test and Mann-Whitney U test using the SPSSWIN 10.0 program. The results of the study are as follows : 1. Hypothesis 1: 'there will be a significant difference between two groups in the level of pain after chest tube removal' was supported (u = 23.00, p < 0.001). 2. Hypothesis 2: 'there will be a significant difference between the two groups in the level of psychological anxiety after chest tube removal' was supported (u = 3.00, p < 0.001). 3. Hypothesis 3: 'there will be a significant difference between the two groups in physiological anxiety(systolic, diastolic blood pressure and pulse rate) after chest tube removal' was supported(u =55.50, p = 0.01 ; u = 41.50, p = 0.01 ; u = 20.50, p < 0.001, relatively). The findings of this study indicate that hand massage is effective for pain and anxiety related to chest tube removal in patients with lobectomy. Therefore, hand massage is recommended as an effective nursing intervention for relieving pain and anxiety in patients undergoing chest tube removal. Further research is needed to identify the proper duration and timing to achieve the optimal effect of hand massage. A larger subject population is required to apply the current findings to the general population. Further research is also needed to assess the effects of hand massage in other patient subsets. Finally, it would be interesting to see if the effects of hand massaging would be attenuated when performed by a non-medical specialist.

• Journal of Chest Surgery
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• v.22 no.6
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• pp.1101-1105
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• 1989

Fifty one patients with empyema thoracic were managed at the Kyung Hee University Medical Center during 5 years between December, 1982, and December, 1987. The patients were classified into two groups; group A [early minithoracotomy-9 patients] and group B[conventional chest tube insertion-42 patients]. Each group was retrospectively analyzed to compare the results in terms of leukocyte count change, body temperature change, duration of hospitalization, elapsed time to chest tube removal and the need for subsequent decortication and tube change. There was no statistical difference between two groups in terms of etiology, age and sex. l. In the group A, mean preoperative leukocyte count [19,300/mme] decreased to 8,688/mme postoperatively. In the group B, leukocyte count changed from 16,985/mme to 14,433/mme. Their differences were significant [P< 0.05]. 2. In the group A, mean preoperative body temperature [38.5] decreased to 36.7. In the group B, body temperature changed from 38.1oC to 37.5 oC. Their differences were significant [P < 0.05]. 3. Mean duration of Hospitalization; 18.2 days [group A], 30.2 days [group B]. Their differences were significant [P < 0.01]. 4. Mean elapsing time for chest tube removal; 15.2 days [group A], 28.5 days [group B]. Their differences were significant [P < 0.01]. 5. There was no need for subsequent decortication and chest tube change in the group A. There were 22 cases [52.3 %] for subsequent decortication and 12 cases [28.6 %] for chest tube change in the group B. Early minithoracotomy in treating empyema thoracis resulted in a shorter hospital stay and a shorter period of tube drainage than conventional method.

• Journal of Chest Surgery
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• v.33 no.9
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• pp.738-743
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• 2000

Background: Video-assisted thoracic surgery(VATS) is being used as a therapeutic modality in many diseases in which thoracotomy has been used. We studied that the VATS can substitute the thoracotomy in benign esophageal disease. Material and Method: Group I (n=18) underwent video-assisted thoracic surgery, and group II(n=19) thoracotomy. Group I includes 14 leiomyomas and 4 achalasias. Group II includes 16 leiomyomas and 3 achalasias. Operative technique is enucleation in the leiomyoma and modified Heller's myotomy in the achalasia. Analyzing factors of operation-efficacy are anesthetic time, operation time, hospital stay, chest tube drainage amount and chest tube removal day. The degree of the postoperative pain is assessed by the frequency of opioid analgesics injection. Result: There was no death in both groups. There were 5 complications in the group I and 2 in the group II. Prolonged pleural effusion and restenosis of achalasia occurred to 1 patient in each group. In the group I, there were 1 temporaty vocal cord palsy and 2 mucosal tear leading to thoracotomy. There were no differences in anesthesia time, operation time, hospital stay, total chest tube drainage amount, chest tube removal day and frequency of opioid analgesics injection. The amount of the chest tube drainage at POD 1 day was significantly lower in group I(155.6$\pm$77.8cc) than in group II(572.8$\pm$280.1cc)(p<0.05). Conclusion: The results of our data showed that video-assisted thoracic surgery for benign esophageal disease is as effective as thoracotomy and in addition, cosmetic effect is much better. We concluded VATS may be a substitute for thoracotomy in benign esophageal disease.

• Journal of Korean Critical Care Nursing
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• v.1 no.1
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• pp.33-45
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• 2008

Purpose: Patients who underwent a coronary artery bypass graft surgery(CABG) experienced the unpleasant emotions and discomfort when their chest tube was removed. The purpose of this study was to evaluate the effects of cold therapy on pain related to chest tube removal(CTR) in CABG patients. Methods: Fifty adult patients undergoing CABG were recruited in a prospective, double blinded study. Subjects were divided into the experimental group and the control group considering their sex and age. The pretest data were obtained 20 minutes before CTR. Patients in the experimental group, received cold therapy for 10 minutes before CTR. Pain sense and intensity were determined immediately after CTR and at 10 minutes after CTR. Results: The total score of pain sense immediately after CTR of the experimental group was significantly lower than that of the control group(t=-3.703, p=.003). And scores of pain intensity immediately after CTR in the experimental group were significantly lower than that of the control group(t=-3.073, p=.001). But, there was no significant difference in the score of pain intensity 10 minutes after CTR between the experimental and the control group(t=1.759, p=.085). Conclusion: The cold therapy would be recommended as an effective and nonpharmacologic nursing intervention for relieving pain in patients undergoing CTR.

• Tuberculosis and Respiratory Diseases
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• v.81 no.2
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• pp.106-115
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• 2018

Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (${\leq}14F$) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general, with the possible exception of hemothoraces and malignant effusions (for which an immediate pleurodesis is planned). Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains. Chest tube insertion should be guided by imaging, either bedside ultrasonography or, less commonly, computed tomography. The so-called trocar technique must be avoided. Instead, blunt dissection (for tubes >24F) or the Seldinger technique should be used. All chest tubes are connected to a drainage system device: flutter valve, underwater seal, electronic systems or, for indwelling pleural catheters (IPC), vacuum bottles. The classic, three-bottle drainage system requires either (external) wall suction or gravity ("water seal") drainage (the former not being routinely recommended unless the latter is not effective). The optimal timing for tube removal is still a matter of controversy; however, the use of digital drainage systems facilitates informed and prudent decision-making in that area. A drain-clamping test before tube withdrawal is generally not advocated. Pain, drain blockage and accidental dislodgment are common complications of small-bore drains; the most dreaded complications include organ injury, hemothorax, infections, and re-expansion pulmonary edema. IPC represent a first-line palliative therapy of malignant pleural effusions in many centers. The optimal frequency of drainage, for IPC, has not been formally agreed upon or otherwise officially established.

• Journal of Chest Surgery
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• v.30 no.11
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• pp.1128-1131
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• 1997

Injuries to versa cave continue to be associated with a high mortality. Essentials to successful treatment are immediate recognition of the injury and prompt control of the hemorrhage. We have experienced one case of inferior versa java perforation by a chest rainage tube in the patient with post-operative chronic empyema thoracic. The patient was 38-year old male who was taken RLL lobectomy after 6 cycle of chemotherapy due to small cell carcinoma in the RLL & suffered from post-operative chronic empyema thoracis at D hospital. He moved to our hospital for further evaluation with accidental removal of chest drainge tube. We inserted closed drainage tube and dark blood gushed out abruptly just after insertion of the drainage tube. CTscan, MRI, and angiogram were performed and showed the perforation of IVC just below RA. The IVC was repaired using simple interrupted 4-0 Prolene suture through right posterolateral thoracotomy. The patient recovered without event and doing well until now.

• Journal of Chest Surgery
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• v.24 no.8
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• pp.765-772
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• 1991

Between 1985 and 1990, 41 patients underwent treatment of the tracheal stenosis. Nineteen patients underwent resection and end-to-end anastomosis including three cases of the subglottic stenosis. Other patients had had treatment such as LASER therapy, bronchoscopic removal, insertion of the Montgomery silastic T-tube or stent insertion Nineteen patients which underwent resection and end-to-end anastomosis were excellent result from three years to sixth months. Other patient were followed at OPD for the other complication or restenosis. There were no hospital death but one patient was managed by bronchoscopic removal of the granulation tissue and other one patient had underwent reoperation for the dehiscence at the anastomotic site.

• Journal of Chest Surgery
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• v.24 no.6
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• pp.570-578
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• 1991

The spontaneous pneumothorax is the sudden collapse of the lung usually by air leakage from the ruptured sub-pleural bleb and has high recurrence rate. For prevention against recurrence, many drugs such as tetracycline, talcum powder, quinacrine, etc. have been used but the effects are not satisfactory. We reduced the recurrence rate successfully by the fibrin glue instillation through the chest tube. From the January 1989 to September 1990, we have managed 65 patients of spontaneous pneumothorax with closed thoracostomy and fibrin glue[fibrinogen 1gm/50ml with approtinin 3, 000kIU /ml, thrombin 5, 000IU /ml in 3% each 10ml] instillation through the chest tube. And we compared the results with those of 106 patients of spontaneous pneumothorax who were managed only by the closed thoracostomy from January 1985 to December 1988. Only the patients who visited our hospital with recurrence were considered as the recurred cases but the others were considered as not recurred. And the removal of chest tubes usually done 3 days after cessation of air leakage or 2 days after fibrin glue instillation Statistical analysis was done by X2-test. The results were as followings: 1. The recurrence rate of fibrin glue instillation group was lower than that of non-instillation group[1st attack: 15.1% versus 27.6% p<0, 05, the 2nd attack: 33.3% versus 73.7% p<0.01, the total 18.5% versus 35.8% p<0.01]. 2. The mean duration of chest tube drainage in the fibrin glue instillation group was shorter than non-instillation group[4.24$\pm$1.36 days versus 4.48$\pm$1.73 days p<0.05]. 3. The mean duration of hospitalization was shorter in the instillation group [8.12$\pm$3.5 days versus 10.8$\pm$3.8 days p<0.05] The complications were transient mild fever, chest pain, pleural effusion in 46 cases of 65 patients, but those didn`t make any problem. We concluded that the fibrin glue is effective in the reduction of recurrence rate, obliteration of air leakage and duration of hospitalization.

• Journal of Chest Surgery
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• v.51 no.4
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• pp.260-265
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• 2018

Background: A method of wound closure using knotless suture material in the chest tube site has been introduced at our center, and is now widely used as the primary method of closing chest tube wounds in video-assisted thoracic surgery (VATS) because it provides cosmetic benefits and causes less pain. Methods: We included 109 patients who underwent VATS pulmonary resection at Samsung Medical Center from October 1 to October 31, 2016. Eighty-five patients underwent VATS pulmonary resection with chest drain wound closure utilizing knotless suture material, and 24 patients underwent VATS pulmonary resection with chest drain wound closure by the conventional method. Complications related to the chest drain wound were compared between the 2 groups. Results: There were 2 cases of pneumothorax after chest tube removal in both groups (8.3% in the conventional group, 2.3% in the knotless suture group; p=0.172) and there was 1 case of wound discharge due to wound dehiscence in the knotless suture group (0% in the conventional group, 1.2% in the knotless suture group; p=0.453). There was no reported case of chest tube dislodgement in either group. The complication rates were non-significantly different between the 2 groups. Conclusion: The results for the complication rates of this new chest drain wound closure method suggest that this method is not inferior to the conventional method. Chest drain wound closure using knotless suture material is feasible based on the short-term results of the complication rate.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.497-501
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• 2009

Background: Prolonged air leakage and pleural fluid drainage from a chest tube may delay removing the chest tube after a patient undergoes video-assisted thoracoscopic wedge resection and the patient is otherwise ready for discharge. We reviewed 37 outpatients patients who were being managed with a postoperative chest tube (a Panda Pneumothorax set with a Heimlich valve). Material and Method: From January 2005 to December 2007, 294 patients underwent video-assisted thoracoscopic wedge resections & pleurodesis. Of them, 37 patients met the criteria for outpatient chest drainage management with using a Panda Pneumothorax set with a Heimlich valve. The patients received written instructions, and they demonstrated competence with using the Panda system. The patients returned for chest tube removal after satisfactory resolution of their air leak and pleural fluid drainage. Result: The patients discharged with a Panda pneumothorax set had a longer duration of hospital stay (mean: 10.3$\pm$1.7 days, range: 11 to 17 days) as compared with the patients without a Panda pneumothorax set (mean: 6.2$\pm$1.5 days, range: 4 to 7 days). The chest tube was removed successfully from the patients with a Panda pneumothorax set at an average of 9.8$\pm$1.6 days (range: 9$\sim$18 days) after discharge. There were no major complications. Four patients experienced minor complications. Thirty six patients (97.3%) experienced uneventful and successful outpatient chest tube management. Conclusion: Successful postoperative outpatient chest tube management with using the Panda set was accomplished in 36 selected patients. This program resulted in a substantially reduced hospital cost and enhanced patient satisfaction by allowing earlier discharge.