A study of the complications of small bore ‘Seldinger’ intercostal chest drains

Abstract

Regular chest drain flushes are advocated in order to reduce rates of drain blockage, and further studies are needed to determine optimal fixation strategies that may reduce associated patient morbidity.

Pleural procedures and thoracic ultrasound: British Thoracic Society pleural disease guideline 2010

“…Small-bore catheters have significantly lower pain scores and analgesia requirements and a greater degree of comfort than in comparable patients in whom large-bore catheters have been inserted for the same indication 71 72. Davies et al described high overall complication rates (42%) with small-bore drains, but the majority of these were dislodgement (21%), blockage (9%) or pain (5%) 51. Collop et al also described a higher complication rate with small-bore drains (36%) than with large-bore drains (9%).…”

“…The most common problem is drain blockage 45 46 and drain dislodgement 51. It is likely that the limiting factor when using a small-bore chest drain is the connecting of a two- or three-way tap as this often has a narrower bore than the drain 76.…”

“…It is likely that the limiting factor when using a small-bore chest drain is the connecting of a two- or three-way tap as this often has a narrower bore than the drain 76. Davies et al suggest that regular flushing reduces the rate of drain blockage51 and studies that employed regular flushing of the drains with either saline or a fibrinolytic drug have higher therapeutic success rates 78–81…”

Survey of major complications of intercostal chest drain insertion in the UK

“…In a prospective assessment of Seldinger drain use by Horsley et al , four of 52 insertions resulted in minor complications; three surgical emphysema, one bleeding wound site, and one case of iatrogenic empyema 4. However, a retrospective case note audit by Davies et al 5 found very few complications following 100 Seldinger chest drain insertions. 21% fell out and 9% of drains became blocked, but no other complications occurred.…”

When size matters: changing opinion in the management of pleural space—the rise of small-bore pleural catheters

“…Usually, complications occur less frequently if the drain is placed by expert operators (senior staff Physicians) or under radiological/ultrasonographic guidance (20). There is no significant difference in complication rates when the chest tube is inserted using the Seldinger technique or …”