Chest
Volume 121, Issue 2, February 2002, Pages 647-649
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Selected Reports
Simple Construction of a Subcutaneous Catheter for Treatment of Severe Subcutaneous Emphysema

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Subcutaneous emphysema often presents a management dilemma. Rarely, subcutaneous emphysema has pathophysiologic consequences. More often, it is extremely uncomfortable for the patient, and is often disfiguring and alarming for patients and family. When subcutaneous emphysema is severe, physicians may feel compelled to treat it, but the currently described techniques are often invasive or ineffective. We describe the use of an easily constructed, minimally invasive, fenestrated catheter that relieves the symptoms of subcutaneous emphysema.

Section snippets

Case Report

A 50-year-old man presented to his family doctor with an exacerbation of COPD. He was initially treated with albuterol and oral steroid therapy (40 mg po once daily, then tapering). The patient's medical history was noncontributory, except for a 50 pack-year smoking history, and he had lost approximately 20 lb over the previous 2 to 3 months. Within a few days, fevers, chills, rigors, and a dry cough developed. He was admitted to the hospital in respiratory distress. His chest radiograph at

Discussion

The catheters are easily constructed. The fenestrations are readily created by leaving the angiocatheter over the steel stylette and using a scalpel blade to create the holes. To enhance the rigidity of the catheter, the fenestrations are created in a spiral pattern. A povidone-iodine swab is used to prepare the skin and, if desired, a small amount of local anesthetic can be used. The site of insertion is 2 to 3 cm lateral to the midclavicular line over the third rib. The catheter is inserted

ACKNOWLEDGMENT

The authors thank Dr. Stephen K. Field, MD, FCCP, for his careful review of the manuscript.

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Dr. Beck is a Clinical Investigator of the Alberta Heritage Foundation for Medical Research, and Dr. Mody is a Scholar of the Alberta Heritage Foundation for Medical Research.

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