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.
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