Supplies needed:
- Oval drape, extra blue towels
- Arteriogram tray (if upsizing of chest tube is indicated)
- Vinyl connecting tubing or three way adaptor
- 60 cc syringe
- New chest tube / dilator (if upsizing)
- New Atrium (type based on which service patient is on)
- Stay-fix
- Large tegaderm
- Split gauze
- Wire: Operator's choice
Patient Prep:
- Supine on VIR table, prep hemithorax around existing chest tube.
Procedure:
- Consent: Exchange / Upsize Chest tube with Autologous Blood Patch, +/- Moderate sedation
- Risks : Infection, worsening pneumothorax, technical failure including need for additional blood patch, +/- respiratory depression
- Place large bore peripheral IV if patient does not have venous access
- Upsize chest tube under fluoro guidance as needed (minimal size of chest tube 10Fr)
- Proceduralist will withdraw 100 cc's of blood (with the 60 cc syringe) from patient and instill into pleural space via chest tube
- Clamp chest tube for TWO hours but leave it attached to atrium
- Patient to roll from side to side every 15 minutes for a two hour period
- After two hours unclamp chest tube and place atrium back to LWS -20 mm Hg overnight