No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Apparent intrahepatic placement of an intercoastal catheter on imaging: What lessons can we re-learn?
Use of tube thoracostomy in intensive care units for evacuation of air or fluid from the pleural space has become commonplace. In addition to recognition of pathological states necessitating chest tube insertion, intensivists are frequently involved in placement, maintenance, troubleshooting, and discontinuation of chest tubes. Numerous advances have permitted safe use of tube thoracostomy for treatment of spontaneous or iatrogenic pneumothoracies and hydrothoracies following cardiothoracic surgery or trauma, or for drainage of pus, bile, or chylous effusions. We review current indications for chest tube placement, insertion techniques, and available equipment, including drainage systems. Guidelines for maintenance and discontinuation are also discussed. As with any surgical procedure, complications may arise. Appropriate training and competence in usage may reduce the incidence of complications.
Objective:
To determine the complication rate and risk factors associated with tube thoracostomy (TT) in the trauma patient.
Design:
Retrospective hospital chart review.
Setting:
Level I trauma center.
Patients:
Four hundred twenty-six consecutive patients who underwent TT were initially reviewed; 47 deaths occurred unrelated to TT placement. The remaining 379 patients required 599 tubes and composed the study population.
Main Outcome Measures:
The determination of adverse outcomes related to TT, including thoracic empyema, undrained hemothorax or pneumothorax, improper tube positioning, post–tube removal complications, and direct injuries to the lung.
Results:
The overall complication rate was 21% per patient. Although complications were not related to the Injury Severity Score, the presence of shock, admission to the intensive care unit, and the need for mechanical ventilation were associated with the increased incidence of complications. There were fewer complications (6%) when the TT was performed by a surgeon compared with TT performed by an emergency physician (13%, P<.0001) or TT performed prior to transfer to our hospital (38%, P<.0001).
Conclusions:
Tube thoracostomy is associated with significant morbidity. The striking difference in the complication rate between surgeons and other physicians who perform this procedure suggests that additional training may be indicated.(Arch Surg. 1995;130:521-526)
The insertion of a chest drain catheter for the management of a pneumothorax in an 82-year-old woman resulted in the unusual complication of liver penetration. The position of the drain was assessed by contrast-enhanced computed tomographic scan. Because the patient was hemodynamically stable and no damage to major vessels was seen on computed tomographic scan, the patient was treated in a nonoperative manner. A procedure was performed under controlled conditions using techniques used during transhepatic liver biopsies but with the addition of a balloon catheter. Embolization of the liver track was performed during chest drain removal. The drain was successfully removed without the complication of bleeding in a patient unsuitable for a general anesthetic.
To determine the complication rate and risk factors associated with tube thoracostomy (TT) in the trauma patient.
Retrospective hospital chart review.
Level I trauma center.
Four hundred twenty-six consecutive patients who underwent TT were initially reviewed; 47 deaths occurred unrelated to TT placement. The remaining 379 patients required 599 tubes and composed the study population.
The determination of adverse outcomes related to TT, including thoracic empyema, undrained hemothorax or pneumothorax, improper tube positioning, post-tube removal complications, and direct injuries to the lung.
The overall complication rate was 21% per patient. Although complications were not related to the Injury Severity Score, the presence of shock, admission to the intensive care unit, and the need for mechanical ventilation were associated with the increased incidence of complications. There were fewer complications (6%) when the TT was performed by a surgeon compared with TT performed by an emergency physician (13%, P < .0001) or TT performed prior to transfer to our hospital (38%, P < .0001).
Tube thoracostomy is associated with significant morbidity. The striking difference in the complication rate between surgeons and other physicians who perform this procedure suggests that additional training may be indicated.
To assess the complication rate of tube thoracostomy in trauma. To consider whether this rate is high enough to support a selective reduction in the indications for tube thoracostomy in trauma.
A retrospective case series of all trauma patients who underwent tube thoracostomy during a 12 month period at a large UK teaching hospital with an accident and emergency (A&E) department seeing in excess of 125,000 new patients/year. These patients were identified using the hospital audit department computerised retrieval system supplemented by a hand search of both the data collected for the Major Trauma Outcome Study and the A&E admission unit log book. The notes were assessed with regard to the incidence of complications, which were divided into insertional, infective, and positional.
Fifty seven chest drains were placed in 47 patients over the 12 month period. Seven patients who died within 48 hours of drain insertion were excluded. The commonest indications for tube thoracostomy were pneumothorax (54%) and haemothorax (20%); 90% of tubes were placed as a result of blunt trauma. The overall complication rate of the procedure was 30%. There were no insertional complications and only one (2%) major complication, which was empyema thoracis.
This study reveals no persuasive evidence to support a selective reduction in the indications for tube thoracostomy in trauma. A larger study to confirm or refute these findings must be performed before any change in established safe practice.
These guidelines have been replaced by BTS Pleural Disease Guideline 2010 Superseded By BTS Pleural Disease Guideline 2010: BTS Guidelines for the Management of Pleural Disease. Thorax 2003 May; 58(Suppl 2): 1–59.