Superior chest drainage with an active tube clearance system: evaluation of a downsized chest tube.

PURPOSE: We developed a small-diameter (20-French [Fr]) chest drainage system that incorporates an active tube clearance (ATC) system, and we evaluated its efficacy in an acute hemothorax model. DESCRIPTION: The ATC system includes an internal guidewire that can be advanced into the lumen of the chest tube to keep the tube from clogging. In six pigs, a 20-Fr ATC tube was placed on one side and a 32-Fr standard tube on the other, and 120 mL of fresh blood was infused into each pleural space every 15 minutes for a total of 840 mL. EVALUATION: The amount of drainage for 2 hours with a 20-Fr ATC tube was significantly greater than that with the 32-Fr standard tube (525 ± 179 mL vs 183 ± 85 mL; p = 0.0032). CONCLUSIONS: This is the first time a smaller diameter tube has been shown to have better drainage in the setting of acute bleeding compared with larger diameter tubes.