Patent Publication Number: US-2020282192-A1

Title: Suture-less chest tube

Description:
TECHNICAL FIELD 
     Embodiments are generally related to the field of medical devices. More particularly, the present embodiments are directed to chest tubes and chest tube thoracostomy. Embodiments are further related to improved methods and systems for chest tubes that do not require sutures. 
     BACKGROUND 
     In emergency and trauma medicine, chest tubes are a common and critically important medical device. Typically, chest tubes are used to treat pneumothorax (air around the lung) and hemothorax (blood or fluid around the lung). These conditions are often the result of chest trauma, such as a gunshot or stab wound, and require immediate emergency medical care. Chest tubes are also used to treat other spontaneous conditions including pneumothorax or hemothorax due to cancer, COPD, and body habitus. 
     Current practice for inserting a chest tube includes making a skin incision across the rib, inserting the chest tube, and then using sutures to secure the tube. The procedure is invasive, painful, and risky. Once the chest tube is inserted, sutures are used to hold the tube in place, and a dressing might be applied. In practice, it is extremely uncommon for a truly air tight seal to be achieved in this way. 
     Prior art chest tubes, and the methods used to install them, can be time consuming, ineffective, and dangerous. For example, the suturing method is very time intensive to complete, which can result in catastrophic time delays in emergency situations. It is difficult to adequately secure the chest tube in place and the incision may be difficult to render sufficiently airtight. As a result, a cumbersome combination of bandages, dressings, and tape are often applied, one at a time, in an effort to seal the area where the tube is sutured to the skin. In addition, sharp objects necessary for sutures increase the transmission risk of infectious diseases to healthcare providers by needle stick injury. 
     Accordingly, there is a need in the art for improved chest tubes that are safer and less time consuming to properly install, as disclosed herein. 
     BRIEF SUMMARY 
     The following summary is provided to facilitate an understanding of some of the innovative features unique to the embodiments disclosed and is not intended to be a full description. A full appreciation of the various aspects of the embodiments can be gained by taking the entire specification, claims, drawings, and abstract as a whole. 
     Various objects and advantages of this use will become apparent from the following description taken in conjunction with the accompanying drawings which describe certain embodiments of this invention. 
     It is, therefore, one aspect of the disclosed embodiments to provide novel methods, systems, and apparatuses associated with chest tubes. 
     Specifically, in an aspect of the embodiments, a suture-less chest tube that can be installed quickly, and with the use of fewer potentially infectious tools, is disclosed. 
     The aforementioned aspects and other objectives and advantages can now be achieved as described herein. For example, in certain embodiments a system comprises a tube for insertion in a patient&#39;s chest cavity, an inflatable sac configured on a first section of the tube, an inflation valve for inflating the inflatable sac, and a flange associated with a second section of the tube configured for securing the tube. The first section of the tube is inserted into the patient&#39;s body and the second section of the tube is external to the patient&#39;s body. The system can further comprise a dressing configured between an external surface of a patient&#39;s body and the flange. The dressing further comprises at least one of: one or more adhesive layers, one or more sealing layers, and one or more gauze layers. The dressing and the flange can be pre-attached to the second section of the tube. In an embodiment the system further comprises a locking member associated with the flange and configured to secure the flange at a location around the second section of the tube. In an embodiment a conduit can be formed in the tube, the conduit being fluidically connected to the inflatable sac and the conduit being fluidically connected to the inflation valve. 
    
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
       The accompanying figures, in which like reference numerals refer to identical or functionally-similar elements throughout the separate views and which are incorporated in and form a part of the specification, further illustrate the embodiments and, together with the detailed description, serve to explain the embodiments disclosed herein. 
         FIG. 1  depicts a chest tube system and/or apparatus, in accordance with the disclosed embodiments; 
         FIG. 2  depicts a chest tube system and/or apparatus deployed in a patient, in accordance with the disclosed embodiments; 
         FIG. 3  depicts an alternative embodiment of a chest tube system and/or apparatus, in accordance with the disclosed embodiments; 
         FIG. 4  depicts a plan view of a chest tube system and/or apparatus, in accordance with the disclosed embodiments; 
         FIG. 5  depicts an embodiment of a flange associated with a chest tube system and/or apparatus, in accordance with the disclosed embodiments; 
         FIG. 6A  depicts an embodiment of a flange associated with a chest tube system and/or apparatus, in accordance with the disclosed embodiments; 
         FIG. 6B  depicts another view of a flange associated with a chest tube system and/or apparatus, in accordance with the disclosed embodiments; 
         FIG. 6C  depicts teeth on a platform associated with a chest tube system and/or apparatus, in accordance with the disclosed embodiments; 
         FIG. 7A  depicts a zip tie system associated with a chest tube system and/or apparatus, in accordance with disclosed embodiments; 
         FIG. 7B  depicts another view of a zip tie system associated with a chest tube system and/or apparatus, in accordance with disclosed embodiments; 
         FIG. 8A  depicts an embodiment of a flange associated with a chest tube system and/or apparatus, in accordance with the disclosed embodiments; 
         FIG. 8B  depicts another view of an embodiment of a flange associated with a chest tube system and/or apparatus, in accordance with the disclosed embodiments; 
         FIG. 9A  depicts an embodiment of a flange associated with a chest tube system and/or apparatus, in accordance with the disclosed embodiments; 
         FIG. 9B  depicts another view of an embodiment of a flange associated with a chest tube system and/or apparatus, in accordance with the disclosed embodiments; 
         FIG. 9C  depicts another view of an embodiment of a flange associated with a chest tube system and/or apparatus, in accordance with the disclosed embodiments; 
         FIG. 10  depicts an embodiment of a flange associated with a chest tube system and/or apparatus in accordance with the disclosed embodiments; 
         FIG. 11A  depicts an embodiment of a flange associated with a chest tube system and/or apparatus, in accordance with the disclosed embodiments; 
         FIG. 11B  depicts components of a flange associated with a chest tube system and/or apparatus, in accordance with the disclosed embodiments; and 
         FIG. 12  depicts a flow chart of steps associated with a method for performing a thoracostomy using the systems and apparatuses disclosed herein, in accordance with the disclosed embodiments. 
     
    
    
     DETAILED DESCRIPTION 
     The particular values and configurations discussed in the following non-limiting examples can be varied, and are cited merely to illustrate one or more embodiments and are not intended to limit the scope thereof. 
     Example embodiments will now be described more fully hereinafter with reference to the accompanying drawings, in which illustrative embodiments are shown. The embodiments disclosed herein can be embodied in many different forms and should not be construed as limited to the embodiments set forth herein; rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the scope of the embodiments to those skilled in the art. Like numbers refer to like elements throughout. 
     The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting. As used herein, the singular forms “a”, “an”, and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprises” and/or “comprising,” when used in this specification, specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and/or groups thereof. 
     Throughout the specification and claims, terms may have nuanced meanings suggested or implied in context beyond an explicitly stated meaning. Likewise, the phrase “in one embodiment” as used herein does not necessarily refer to the same embodiment and the phrase “in another embodiment” as used herein does not necessarily refer to a different embodiment. It is intended, for example, that claimed subject matter include combinations of example embodiments in whole or in part. 
     Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art. It will be further understood that terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning that is consistent with their meaning in the context of the relevant art and will not be interpreted in an idealized or overly formal sense unless expressly so defined herein. 
     It is contemplated that any embodiment discussed in this specification can be implemented with respect to any method, kit, reagent, or composition of the invention, and vice versa. Furthermore, compositions of the invention can be used to achieve methods of the invention. 
     It will be understood that particular embodiments described herein are shown by way of illustration and not as limitations of the invention. The principal features of this invention can be employed in various embodiments without departing from the scope of the invention. Those skilled in the art will recognize, or be able to ascertain using no more than routine experimentation, numerous equivalents to the specific procedures described herein. Such equivalents are considered to be within the scope of this invention and are covered by the claims. 
     The use of the word “a” or “an” when used in conjunction with the term “comprising” in the claims and/or the specification may mean “one,” but it is also consistent with the meaning of “one or more,” “at least one,” and “one or more than one.” The use of the term “or” in the claims is used to mean “and/or” unless explicitly indicated to refer to alternatives only or the alternatives are mutually exclusive, although the disclosure supports a definition that refers to only alternatives and “and/or.” Throughout this application, the term “about” is used to indicate that a value includes the inherent variation of error for the device, the method being employed to determine the value, or the variation that exists among the study subjects. 
     As used in this specification and claim(s), the words “comprising” (and any form of comprising, such as “comprise” and “comprises”), “having” (and any form of having, such as “have” and “has”), “including” (and any form of including, such as “includes” and “include”) or “containing” (and any form of containing, such as “contains” and “contain”) are inclusive or open-ended and do not exclude additional, unrecited elements or method steps. 
     The term “or combinations thereof” as used herein refers to all permutations and combinations of the listed items preceding the term. For example, “A, B, C, or combinations thereof” is intended to include at least one of: A, B, C, Aft AC, BC, or ABC, and if order is important in a particular context, also BA, CA, CB, CBA, BCA, ACB, BAC, or CAB. Continuing with this example, expressly included are combinations that contain repeats of one or more item or term, such as BB, AAA, Aft BBC, AAABCCCC, CBBAAA, CABABB, and so forth. The skilled artisan will understand that typically there is no limit on the number of items or terms in any combination, unless otherwise apparent from the context. 
     All of the compositions and/or methods disclosed and claimed herein can be made and executed without undue experimentation in light of the present disclosure. While the compositions and methods of this invention have been described in terms of preferred embodiments, it will be apparent to those of skill in the art that variations may be applied to the compositions and/or methods and in the steps or in the sequence of steps of the method described herein without departing from the concept, spirit and scope of the invention. All such similar substitutes and modifications apparent to those skilled in the art are deemed to be within the spirit, scope and concept of the invention as defined by the appended claims. 
     The embodiments disclosed herein provide a chest tube apparatus that can be used to treat patients who require a chest tube thoracostomy. The embodiments disclosed herein do not require sutures. In the embodiments, a chest tube includes an inflatable sac or balloon (also known as a cuff) and a novel tube-securing flange, which, in conjunction, can be used to secure the chest tube in the patient at the desired position, without sutures. 
       FIG. 1  illustrates an exemplary embodiment of a chest tube system  100 . The chest tube system generally includes a chest tube  105  that has a fluted distal (internal to the patient) end  110 . The chest tube  105  can be formed of medical grade plastic, rubber, or other such material. It should be appreciated that the chest tube can be sterile, or sterilized, prior to use. 
     The flutes  115  on the fluted end of the chest tube  110  comprise a series of one or more openings in the chest tube  100 . The flutes  115  provide an entry point for liquid or gas to enter the chest tube  105 . The flutes  115  are generally ovular in shape, but can be other shapes according to design considerations. 
     The distal end  110  can further include a shaped opening  120 . In an embodiment, the shaped opening  120  can be selected to facilitate insertion of the chest tube into a chest cavity. In particular, the shape can be selected to facilitate insertion of the tube through the incision in the patient, and in and through the tissues between the patient&#39;s ribs. As such, in an embodiment, the shaped opening  120  can be pointed, blunt, beveled, conical, sprotte, diamond (Franseen), tuohy, or other such shape that may facilitate insertion of the tube into the chest cavity. 
     The fluted end of the chest tube  110  further includes an inflatable and deflatable cuff or balloon  125 . The balloon  125  is connected to one or more lumens  130  that can be connected to a port or valve  135 . The lumen  130  is preferably integrated in the tube  105  or is configured inside tube  105 , in order to prevent the lumen from accidentally being pulled into the chest cavity. In other embodiments, the lumen can be formed on the exterior of, or be external from, the tube  105 . The lumen  130  allows gas (i.e., air), or medical grade liquid, to flow into, or out of, cuff  125 . 
     The valve  135  is generally configured to allow air (or liquid) to flow into, and out of, the balloon  125  via the lumen  130 . The valve  135  can comprise a standard port configured to connect with a syringe, or other source of flowing gas  140 . It should be understood that the volume of the cuff  125  can be known, and the volume of gas provided to the cuff, for example, via syringe, can match the maximum cuff volume, in order to avoid over inflation. 
     The other (external to the patient) end  145  of the chest tube  105  is configured with a flange  150 . The flange  150  has a conduit that fits around the chest tube  105 , so that the location of the flange  150  on the chest tube  105  can easily be adjusted. The flange  150  further includes a locking mechanism  160  that secures the flange  150  to the chest tube  105  in the desired location. The locking mechanism  160  can comprise any number of arrangements as further disclosed herein. In some embodiments, the flange  150  can be stiff (i.e., formed of hard rubber, plastic, metal, etc.) when a stiff and robust position of the flange is desirable. In other embodiments, the flange  150  may be flexible in order to help provide an airtight seal around an incision. 
     In additional embodiments, one or more integrated dressings  155  can be configured on the flange and/or on the tube  105 . The integrated dressing  155  can comprise one or more of a dry gauze pad, a lubricated pad, an adhesive pad, an additional or integrated Tegaderm™ pad, and the like. It should be understood that one or more of the dressings can be sterile. The integrated dressings  155  can also be provided individually when one of the layers of dressing is not required. In some embodiments, the integrated dressing  155  can have a surface area that far exceeds the size of the incision (e.g., approximately 30 square inches or less) in order to improve the seal provided by the system. 
     The chest tube system  100  provides an improved means for inserting and securing a chest tube in a patient.  FIG. 2  illustrates a view of the chest tube  100  in use. In practice, the distal end  110  (i.e., the end internal to the patient) of tube  105  can be inserted into the chest cavity  200  of a patient. Before insertion, cuff  125  is deflated to improve the ease with which the tube  105  can be inserted. 
     Once the chest tube is inserted, the cuff  125  can be inflated with air, another gas, or a safe liquid solution, via syringe  140 . After insertion, the tube  105  can be retracted slightly so that the cuff  125  fits snuggly against the inner surface  205  of the chest cavity  200 . The distal end  110  of the tube  105  is thus secured within the chest cavity  200  and cannot be pulled out. 
     The flange  150  can be secured on the outside surface  210  of the body. In certain embodiments, the integrated dressings  155  are configured between the incision on the patient and the flange  150 . The flange  150  can be secured to the chest tube  105  by locking mechanism  160 . The patient&#39;s body is thus sandwiched between the cuff  125  on the inside and the flange  150  on the outside, so that the tube  105  is held securely in place. The tube  105  then functions as any standard chest tube allowing liquids and gasses trapped in the chest cavity to escape, as vacuum  215  is pulled through the tube  105 . In some embodiments, the tube  105  can be attached to a standard Pleurovac™, or other such vacuum seal device. 
     Not only is this procedure much faster than prior art approaches, if the location of the chest tube requires adjustment, or removal, it is a simple exercise to release locking mechanism  160 , deflate cuff  125 , and reposition or remove the chest tube system  100 . 
       FIG. 3  illustrates an alternative embodiment of a system  300 . It should be appreciated that like features are identified with the same reference numerals throughout the figures. In system  300 , the flange is replaced by an adjustable exterior balloon  305 . In such embodiments, the balloon  305  can be adjusted on the exterior of the patient to secure the tube  105 , in the same manner as the flange. When the tube is in its proper position, the balloon  305  can be inflated. The pressure from the inflation of balloon  305  secures the balloon at a desired location along tube  105  so that the tube is secured in place once it is installed in the patient. It should be understood that the adjustable exterior balloon  305  can be integrally connected to lumen  130 , or an additional dedicated lumen  310  and valve assembly  315  can be connected to balloon  305  according to design considerations. 
     Flange  150  and locking mechanism  160  can be embodied in a number of different ways.  FIGS. 4-11  illustrate a variety of embodiments of flange  150  and locking mechanisms  160  that can be implemented with chest tube system  100 . 
       FIG. 4  illustrates an embodiment of flange  150  employing a resistance fit. In general, flange  150  includes a first platform  405 , which has a wider diameter, and a second platform  410  that extends from the surface of the first platform  405  in the direction opposite the patient. A conduit  415  for the chest tube  105  passes through both first platform  405  and second platform  410 . The conduit can include recess  420  to accommodate lumen  130 , when the lumen is exterior to chest tube  105 , or when the shape of chest tube  105  is modified by the integration of lumen  130 . 
     In the embodiment illustrated in  FIG. 4 , a series of resistive protrusions  425 , including but not limited to, fluting, dimples, ridges or the like, can be formed on the surface of conduit  415 . The resistive protrusions serve to hold the chest tube  105  in place by exerting resistive frictional forces on the chest tube  105 . In some embodiments, it may be necessary to squeeze chest tube  105  so that it can pass through conduit  415 . Once the chest tube  105  and flange  150  are correctly positioned, the chest tube  105  can be released so that the resistive protrusions hold the chest tube  105  and flange  150  in place. 
       FIG. 5  illustrates an embodiment of flange  150  employing a compression and nut fitting. In this embodiment, the flange  150  comprises a first platform  405  with a male threaded compression sleeve  510  formed thereon. The male threaded compression sleeve is generally configured to fit around chest tube  105 , such that when a female compression nut  505  is engaged with the male threaded compression sleeve  510 , the sleeve  510  is compressed around the chest tube  105  so that the flange  150  is held in a desired location. It should be appreciated that, in this arrangement and the remaining arrangements, recess  420  may still be included in the flange  150  to accommodate lumen  130 . 
       FIG. 6A  illustrates an embodiment of flange  150  employing a zip tie retention configuration. In this embodiment, the flange  150  includes first platform  405  and second platform  410 , and is configured so that chest tube  105  can pass through conduit  415 . The second platform  410  can have two or more slots  605  (only one slot  605  is visible in the figure, but more can be included) through which a zip tie  610  can pass. The slots  605  are preferably biased toward the same side of second platform  410  such that a zip tie  610  (or other such device including string, suture, tape, rubber band, etc.) can be passed through the two slots  605 . The chest tube  105  can then be inserted through the conduit  415  and the flange  150  and can be adjusted to the desired position with respect to the chest tube  105 . It should be understood that, in other embodiments, the chest tube  105  can be inserted in the conduit  415  before the zip tie  610  is inserted through the slots  605 . With the flange  150  properly in place, the zip tie  610  can be secured around a portion of the tube  105  and a portion of the exterior of second platform  410 , in order to secure the flange  150  at the desired location. 
     The zip tie  610  can be made of nylon or other such flexible material. The zip tie has a flexible section  625  with teeth that engage with a pawl  615  at the end that provides a ratchet type lock. As the free end  620  of the flexible section  625  is pulled, the zip tie tightens and the teeth engage in the pawl  615  so that the free end cannot be retracted. In some embodiments, zip ties can include a tab that can be depressed to release the ratchet so that the zip tie can be loosened or removed. 
       FIG. 6B  illustrates a second view of the implementation of the zip tie retention embodiment. Note that the zip tie  610  is preferably secured against the chest tube  105  via slots  605 . The zip tie  610  is then secured around the opposite exterior side of second platform  410  in order to provide a strong grip against the chest tube  105  and prevent movement of the flange  150  along the chest tube  105 .  FIG. 6C  illustrates that, in certain embodiments, one or more teeth  630  and  635  can be configured on the internal surface of the second platform  410 . In general, when the zip tie  610  is tightened, the teeth  630  and  635  engage against the tube  105  as the tube is pulled tightly against the sides of conduit  415 . The teeth  630  and  635  can provide additional grip against tube  105  after it is passed through conduit  415 , in order to better secure the tube  105  in place. 
       FIG. 7A  illustrates an alternative embodiment wherein a zip tie strip of teeth is formed on one or more sides of the chest tube. In this embodiment, the chest tube  105  can be configured with external strips of zip tie teeth  705 . The strips  705  can be located at 90 degrees from one another (or at other desired intervals) along the exterior of the chest tube.  FIG. 7B  illustrates an elevation view of chest tube  105  configured with strips of zip tie teeth  705 . 
     A zip tie nut  710  can be configured to engage the teeth in the strips  705 . When the flange  150  is in a desired location, the zip tie nut  710  can be secured against the first platform  405 . In cases where it is desirable to adjust the location of the flange  150 , the zip tie nut  710  can be rotated (for example, 45 degrees, although other rotational angles may also be applied) so that it disengages from the strips  705 . The flange can then be readjusted along the chest tube  105  and the zip tie nut can be reengaged. 
       FIG. 8A  illustrates another embodiment of flange  150  employing a setscrew fitting to secure the flange  150  in place on chest tube  105 . In this embodiment, the flange  150  includes a first platform  405  and second platform  410 . The second platform  410  includes a threaded channel  805 . The threaded channel  805  is formed to accept a setscrew  810 . 
     When the flange  150  has been adjusted to the correct position on chest tube  105 , setscrew  810  is engaged until it is in secure contact with chest tube  105 . In some embodiments, setscrew  810  can include a sharp, pointed, jagged, or otherwise engaging tip  815 . The tip  815  is intended to form a solid connection with the chest tube  105  so that the flange  150  is held securely in place on the chest tube  105 . It should be appreciated that the tip  815  is preferably formed to bite into the chest tube  105  without penetrating into the interior of the chest tube  105 . 
       FIG. 8B  illustrates a different view of the setscrew fitting. As illustrated, in some embodiments, a setscrew nut  820  can be provided in channel  805 . In such embodiments, the setscrew  810  can be engaged with setscrew nut  820 , which holds the screw in place against the chest tube  105 . 
       FIG. 9A  illustrates an embodiment of flange  150  employing a spring-loaded setscrew fitting. In this embodiment, the flange  150  includes a first platform  405  and second platform  410 . The second platform  410  includes a channel  905 . The channel  905  is formed to accept a setscrew  810 , which is held in place with spring  910 . 
     When the flange  150  has been adjusted to the correct position on chest tube  105 , setscrew  810  is engaged until it is in secure contact with chest tube  105 . Spring  910  holds the setscrew against the chest tube  105 . In some embodiments, setscrew  810  can include a sharp, pointed, or jagged, or otherwise engaging tip  815 . The tip  815  is intended to form a solid connection to the chest tube  105  so that the flange  150  is held securely in place on the chest tube  105 . It should be appreciated that the tip  815  is preferably formed to bite into the chest tube  105  without penetrating into the interior of the chest tube  105 . 
       FIG. 9B  and  FIG. 9C  illustrate two respective views of the spring-loaded setscrew fitting. As illustrated, in some embodiments, the spring  910 , compressed by nut  915 , can be provided in channel  905 . In such embodiments, the setscrew  810  can be held in place by spring  910  against the chest tube  105 . 
       FIG. 10  illustrates an embodiment of flange  150  employing a hose clamp fitting. In this embodiment, the flange  150  includes first platform  405  and second platform  410 , and is configured so that chest tube  105  can pass through conduit  415 . The second platform has two or more slots  605  through which a clamp  1005  can pass. The slots  605  are preferably biased toward the same side of second platform  410  such that clamp  1005  (or other such device, including a hose clamp, butterfly clamp, etc.) can be passed through the two slots  605 . The chest tube  105  can then be inserted through the conduit  415  and the flange  150  can be adjusted to the desired position with respect to the chest tube  105 . It should be understood that in other embodiments, the chest tube  105  can be inserted in the conduit  415  before the clamp  1005  is inserted through the slots  605 . With the flange  150  properly in place, the clamp  1005  can be secure around the exterior of second platform  410  in order to secure the flange  150  at the desired location. 
       FIG. 11A  illustrates an embodiment of flange  150  employing a compression fitting. In this embodiment, the flange  150  includes first platform  405  and second platform  410 , and is configured so that chest tube  105  can pass through conduit  415 . The second platform  410  includes an orifice  1105  and a retention plug  1110 . The retention plug  1110  is formed to fit in the orifice  1105 . The embodiment further includes a clamping cap  1115  that comprises a semicircular or crescent shaped cap. The interior diameter of the clamping cap matches, or is slightly larger than, the diameter of second platform  410 . The various components of this embodiment are illustrated in  FIG. 11B . 
     The chest tube  105  can be inserted through the conduit  415  and the flange  150  can be adjusted to the desired position with respect to the chest tube  105 . With the flange  150  properly in place, the clamping cap  1115  can be slid around the exterior of second platform  410 . The opened portion of the clamping cap  1115  is positioned so that the orifice  1105 , and retention plug  1110 , remains exposed. 
     In order to secure the flange  150  at the desired location, the clamping cap  1115  can be rotated as illustrated by arrow  1120 , such that the retention plug  1110  is forced into contact with the chest tube  105 . In certain embodiments, the retention plug  1110  can have a textured or gripping bottom surface so that additional friction is present between the retention plug  1110  and the chest tube  105 , when the clamping cap  1115  is rotated into place. In order to release the flange  150 , the clamping cap is rotated, again according to arrow  1120 , until the gap in the clamping cap  1115  exposes the retention plug  1110 . 
       FIG. 12  illustrates steps of a method for securing a chest tube in a patient according to the embodiments disclosed herein. The method begins at step  1205 . At step  1210 , a chest tube device can be configured according to the embodiments presented herein. The device can be comprised of a kit including a chest tube with an integrated cuff and lumen, a flange, a knife or scalpel, and one or more clamps including a mayo clamp, perfusionist clamp, or other similar clamps. The entire kit can be sterilized. 
     Next, at step  1215 , an incision can be made in the patient&#39;s chest area. At step  1220 , the chest tube can be inserted into the patient&#39;s chest. It should be appreciated that the chest tube can be inserted such that it does not pinch or damage the neurovascular bundle that runs along the patient&#39;s ribs. The chest tube is inserted far enough that the balloon or cuff, integrated on the tube, is positioned inside the patient&#39;s chest cavity. Preferably, the tube is not inserted too far into the chest cavity, in order to avoid tube blockage, and to avoid damage to the heart or blood vessels in the chest. 
     At step  1225 , the balloon or cuff inside the chest cavity can be inflated, and the chest tube can be positioned so that the cuff is snuggly positioned against the interior wall of the chest cavity at step  1230 . 
     Next at step  1235 , a dressing can be positioned against the exterior of the patient. It should be appreciated that in some embodiments, the dressing can be one or more layers of dressing integrated on the first platform of the flange. In other embodiments, the dressing can be a standalone arrangement of one or more layers of dressing with a hole that allows the dressing to fit around the chest tube. In either case, the dressing can include sterilized gauze layers (regular or Vaseline™ gauze), sterilized adhesive layers, and can be soft or rigid. In some embodiments, one or more of the layers can be Tegaderm™ or other such material. 
     At step  1240 , the flange can be positioned along the chest tube such that the chest tube is held in a desired location. In most cases, the flange can be snugged up against the exterior of the patient, effectively sealing the incision in the patient. The inflated balloon serves to hold the chest tube in place inside the chest cavity, while the flange holds the chest tube in place on the exterior of the chest cavity. At step  1245 , the flange can be secured in place using any of the retention mechanism embodiments disclosed herein. 
     With the chest tube securely in place, suction can be applied through the chest tube in order to draw fluid or gas out of the chest cavity as shown at step  1250 . In certain embodiments, this can be accomplished with a Pleurovac™ device or other similar device. The method ends at step  1255 . 
     It should be appreciated that in cases where a patient is suffering from a pneumothorax (i.e., a simple or tension pneumothorax), a hemothorax (again including a simple or tension hemothorax), or other such condition, it is often critically important to insert a chest tube as quickly as possible to relieve the pressure building in the chest cavity. The systems and methods disclosed herein provide an extremely efficient means for inserting a chest tube and sealing the incision in the patient; no sutures are required. Also, the systems and methods disclosed herein prevent unsterile regions of the tube from entering the body. The disclosed embodiments are thus faster and more effective than prior art methods for securing a chest tube in place, which can be critical in emergency trauma situation. 
     Based on the foregoing, it can be appreciated that a number of embodiments, preferred and alternative, are disclosed herein. For example, in an embodiment, a system comprises a tube for insertion in a patient&#39;s chest cavity, an inflatable sac configured on a first section of the tube, an inflation valve for inflating the inflatable sac, and a flange associated with a second section of the tube configured for securing the tube. In an embodiment, the first section of the tube is inserted into the patient&#39;s body and the second section of the tube is external to the patient&#39;s body. 
     In an embodiment, the system further comprises a dressing configured between an external surface of a patient&#39;s body and the flange. In an embodiment, the dressing further comprises at least one of: one or more adhesive layers, one or more sealing layers, and one or more gauze layers. In an embodiment the dressing and the flange are pre-attached to the second section of the tube. 
     In an embodiment, the system further comprises a locking member associated with the flange and configured to secure the flange at a location around the second section of the tube. 
     In an embodiment, the system further comprises a conduit formed in the tube, the conduit being fluidically connected to the inflatable sac and the conduit being fluidically connected to the inflation valve. 
     In another embodiment, a chest tube apparatus comprises a tube for insertion in a patient&#39;s chest cavity, an inflatable cuff configured on the tube, an inflation valve for inflating the inflatable cuff, and a flange associated with the tube configured for securing the tube. In an embodiment, the tube further comprises a first section and a second section, wherein the cuff is formed on the first section of the tube and is inserted into the patient&#39;s body, and wherein the second section of the tube holds the flange and is external to the patient&#39;s body. 
     In an embodiment, the apparatus further comprises a dressing configured between an external surface of a patient&#39;s body and the flange. The dressing further comprises at least one of: one or more adhesive layers, one or more sealing layers, and one or more gauze layers. The dressing and the flange are pre-attached to the second section of the tube. In an embodiment the dressing is integrated on the flange. 
     In an embodiment, the apparatus further comprises a locking member associated with the flange and configured to secure the flange at a location around the tube. 
     In an embodiment, the apparatus further comprises a conduit formed in the tube, the conduit being fluidically connected to the inflatable cuff and the conduit being fluidically connected to the inflation valve. 
     In yet another embodiment, a method for chest tube thoracostomy comprising: inserting a chest tube in a patient, the chest tube comprising an inflatable cuff, an inflation valve, and a flange, inflating the inflatable cuff via the inflation valve, adjusting a position of the chest tube in the patient, and securing the chest tube at the position with the flange. 
     In an embodiment, adjusting a position of the chest tube further comprises drawing the chest tube out of the patient until the cuff contacts an internal chest wall of the patient. 
     In an embodiment the method further comprises applying a dressing between an external surface of a patient&#39;s body and the flange. In an embodiment the dressing further comprises at least one of: one or more adhesive layers, one or more sealing layers, and one or more gauze layers. 
     In an embodiment securing the chest tube at the position with the flange further comprises engaging a locking member associated with the flange to secure the flange at the location around the tube. 
     It will be appreciated that variations of the above-disclosed and other features and functions, or alternatives thereof, may be desirably combined into many other different systems or applications. Various presently unforeseen or unanticipated alternatives, modifications, variations or improvements therein may be subsequently made by those skilled in the art which are also intended to be encompassed by the following claims.