National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia.
Trauma Service, Alfred Health, Melbourne, Victoria, Australia.
Emerg Med Australas. 2022 Dec;34(6):954-958. doi: 10.1111/1742-6723.14019. Epub 2022 May 26.
The present study aimed to determine the difference in force required to puncture simulated pleura comparing Kelly clamps to fine artery forceps. The treatment of symptomatic traumatic pneumothorax and haemothorax involves puncture of the parietal pleura to allow decompression. This is usually performed using Kelly clamps or fine artery forceps. Over-puncture pulmonary injury risk increases with the force used.
An experienced single operator performed puncturing of simulated parietal pleura on a thoracic mannequin while wearing a force sensor under gloves. The force imparted at the device tip onto the parietal pleura was estimated by subtracting the force required to hold the device from the total force. Outcome variables were the total maximum force and force imparted by the device.
There were 11 simulated procedures completed, seven using Kelly clamps and four using fine artery forceps. After subtracting the force required to hold the chosen forceps, the median value of pleural puncture force using Kelly clamps was 52.91 N (IQR 36.68-63.56) and 10.70 N (IQR 7.64-26.56) using fine artery forceps (P = 0.006).
A significantly increased force was required to puncture simulated parietal pleura using Kelly clamps compared to fine artery forceps. This higher puncture force will be associated with increased instrument acceleration at the time of pleural puncture, which may result in an increased risk of injury to the underlying lung. Based on these data, clinicians may reduce the risk of pulmonary injury by using fine artery forceps rather than Kelly clamps when performing pleural decompression.
本研究旨在比较凯利钳和精细动脉止血钳在模拟胸膜穿刺时所需穿刺力的差异。治疗症状性创伤性气胸和血胸涉及穿刺壁层胸膜以进行减压。这通常使用凯利钳或精细动脉止血钳进行。随着使用的力的增加，过度穿刺肺损伤的风险会增加。
一名经验丰富的操作人员在戴手套的情况下，在胸部模型上进行模拟壁层胸膜穿刺，同时在手套下佩戴力传感器。通过从总力中减去握持器械所需的力来估计器械尖端施加在壁层胸膜上的力。主要观察指标是总最大力和器械施加的力。
共完成 11 次模拟操作，其中 7 次使用凯利钳，4 次使用精细动脉止血钳。在减去握持所选止血钳所需的力后，使用凯利钳进行胸膜穿刺的中位数穿刺力为 52.91 N（IQR 36.68-63.56），使用精细动脉止血钳为 10.70 N（IQR 7.64-26.56）（P=0.006）。
与精细动脉止血钳相比，使用凯利钳穿刺模拟壁层胸膜所需的力明显增加。这种更高的穿刺力将与胸膜穿刺时器械加速度的增加相关，这可能导致肺下损伤的风险增加。基于这些数据，临床医生在进行胸膜减压时，使用精细动脉止血钳而不是凯利钳可能会降低肺损伤的风险。
