You have a pulseless hypothermic patient requiring aggressive internal rewarming. ECMO is not available, and you’ve made the decision to initiate thoracic lavage. After placing your chest tubes, you step back triumphantly, but in short order, the nurse hands you large diameter IV tubing with warmed fluids so that you can connect it to the chest tube. You are left with the IV tubing in one hand and a chest tube in the other with no time to waste, but no elegant or straightforward solution to interface the two.
Trick of the Trade
Using Foley bag tubing
The tube from a standard Foley bag, available in all emergency departments, contains a Luer lock near the tapered nozzle. This unique connector setup allows you to instill warm fluids into the thoracic space with minimal spillage.
Technique for Rewarming
- Attach the warmed IV fluids to the Luer lock port on the Foley bag tubing.
- Insert the tapered nozzle on the Foley bag tubing (typically interfaces with the urine drainage port of the Foley catheter) into the chest tube.
- Clamp the remainder of the Foley bag tubing just proximal to the Luer lock to minimize backflow of IV fluids into the bag.
- Optional: Cut the tubing proximal to the clamp to declutter the space around the interface.
- Instill warm fluid through one chest tube and drain it from the adjacent chest tube.
- Continue rewarming resuscitation protocols.
IV tubing connected to chest tube via Foley bag tube (left photo is a closeup view with arrow designating IV fluid flow)
Read other Tricks of the Trade posts.
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