Chest drain insertion is not a harmless procedure – are we doing it safely?

Elsayed, Hany; Roberts, Rebecca; Emadi, Mehrdad; Whittle, Ian R.; Shackcloth, Michael

doi:10.1510/icvts.2010.243196

Cited by 50 publications

(35 citation statements)

References 11 publications

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“…10 A further study by Elsayed et al showed that only 44% of junior doctors indicated that they would insert an ICD in the triangle of safety. 11 Furthermore, only 58% of junior doctors working in surgery had sufficient knowledge for safe insertion of ICDs.…”

Section: Discussionmentioning

confidence: 99%

An audit of the complications of intercostal chest drain insertion in a high volume trauma service in South Africa

Kong

Oosthuizen

Sartorius

et al. 2014

annals

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INTRODUCTION Intercostal chest drain (ICD) insertion is a commonly performed procedure in trauma and may be associated with significant morbidity. METHODS This was a retrospective review of ICD complications in a major trauma service in South Africa over a four-year period from January 2010 to December 2013. RESULTS A total of 1,050 ICDs were inserted in 1,006 patients, of which 91% were male. The median patient age was 24 years (interquartile range [IQR]: 20-29 years). There were 962 patients with unilateral ICDs and 44 with bilateral ICDs. Seventy-five per cent (758/1,006) sustained penetrating trauma and the remaining 25% (248/1006) sustained blunt trauma. Indications for ICD insertion were: haemopneumothorax (n=338), haemothorax (n=314), simple pneumothorax (n=265), tension pneumothorax (n=79) and open pneumothorax (n=54).Overall, 203 ICDs (19%) were associated with complications: 18% (36/203) were kinked, 18% (36/203) were inserted subcutaneously, 13% (27/203) were too shallow and in 7% (14/203) there was inadequate fixation resulting in dislodgement. Four patients (2%) sustained visceral injuries and two sustained vascular injuries. Forty-one per cent (83/203) were inserted outside the 'triangle of safety' but without visceral or vascular injuries. One patient had the ICD inserted on the wrong side. Junior doctors inserted 798 ICDs (76%) while senior doctors inserted 252 (24%). Junior doctors had a significantly higher complication rate (24%) compared with senior doctors (5%) (p<0.001). There was no mortality as a direct result of ICD insertion. CONCLUSIONS ICD insertion is associated with a high rate of complications. These complications are significantly higher when junior doctors perform the procedure. A multifaceted quality improvement programme is needed to improve the situation.

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Section: Discussionmentioning

confidence: 99%

An audit of the complications of intercostal chest drain insertion in a high volume trauma service in South Africa

Kong

Oosthuizen

Sartorius

et al. 2014

annals

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“…The invasive procedure is associated with more complications if the doctor is inexperienced or inadequately trained [6, 7]. To perform a successful procedure, the doctor requires knowledge of chest wall anatomy [8], aseptic techniques, pleural ultrasound [9-11], and basic surgical skills, as well as experience with the pigtail catheter system and an understanding of the therapeutic and diagnostic qualities of the procedure. TPCT can be performed in two different ways: using the Seldinger technique or the trocar method (in some studies referred to as the direct method).…”

Section: Introductionmentioning

confidence: 99%

Ensuring Basic Competence in Thoracentesis

et al. 2019

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Background: Trocar pigtail catheter thoracentesis (TPCT) is a common procedure often performed by junior physicians. Simulation-based training may effectively train physicians in the procedure prior to performing it on patients. An assessment tool with solid validity evidence is necessary to ensure sufficient procedural competence. Objectives: Our study objectives were (1) to collect evidence of validity for a newly developed pigtail catheter assessment tool (Thoracentesis Assessment Tool [ThorAT]) developed for the evaluation of TPCT performance and (2) to establish a pass/fail score for summative assessment. Methods: We assessed the validity evidence for the ThorAT using the recommended framework for validity by Messick. Thirty-four participants completed two consecutive procedures and their performance was assessed by two blinded, independent raters using the ThorAT. We compared performance scores to test whether the assessment tool was able to discern between the two groups, and a pass/fail score was established. Results: The assessment tool was able to discriminate between the two groups in terms of competence level. Experienced physicians received significantly higher test scores than novices in both the first and second procedure. A pass/fail score of 25.2 points was established, resulting in 4 (17%) passing novices and 1 (9%) failing experienced participant in the first procedure. In the second procedure 9 (39%) novices passed and 2 (18%) experienced participants failed. Conclusions: This study provides a tool for summative assessment of competence in TPCT. Strong validity evidence was gathered from five sources of evidence. A simulation-based training program using the ThorAT could ensure competence before performing thoracentesis on patients.

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“…It seems that chest drain insertion through the safe triangle after local anesthesia is simple. However, less than 50% junior doctors could mark the safe triangle correctly for chest drain insertion 2 . If the chest drain is in the correct position, there should be swinging of the water column during patient's respiration and the gush of air coming out during patient's coughing.…”

Section: Resultsmentioning

confidence: 99%

Root Cause of Analysis of Peculiar Response of Pneumothorax to Chest Tube Drainage

Ho¹

2015

ujmsj

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Chest tube drainage is a simple system to manage pneumothorax. It is inserted at the safety triangle after local anesthesia. Due to the positive intrapulmonary pressure and the negative intrapleural pressure during inspiration, air in the pleural space will be forced out into the chest drain bottle with underwater seal. The resorption of pneumothorax is further enhanced by oxygen therapy, which displaces the nitrogen inside the pneumothorax. Out of our expectation, there are cases with peculiar response to chest tube drainage. We should consider the following in the root cause analysis. 1. Chest drain system integrity: The chest drain should be placed in the pleural cavity, rather than sub-cutaneous or intra-abdominal cavity. The tubing should not be kinked or disconnected and the connection site should not be masked by dressing. 2. Anatomy of the pneumothorax: The anatomy of the pneumothorax should be on CXR or preferably contrast CT thorax. Any loculation, endobronchial obstruction, trapped lung due to old inflammatory process, lung entrapment due to persistent active inflammatory process should be noted. 3. Clinical assessment: It includes pleural fluid analysis, if present, and pleural manometry with air aspiration. In case of persistent air-leak seen in the chest drain bottle, suspect alveolopleural or bronchopleural fistula especially when patient is on positive pressure ventilation. Alternating or persistent bilateral pneumothorax without air-leak suggests interpleural communication (Simultaneous Bilateral Spontaneous Pneumothorax). The observed phenomena can be explained by considering the pressure change between various intra-thoracic compartments accounts for the observed phenomena, although confirmation of the communication during thoracoscopy is preferred.

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Chest drain insertion is not a harmless procedure – are we doing it safely?

Cited by 50 publications

References 11 publications

An audit of the complications of intercostal chest drain insertion in a high volume trauma service in South Africa

An audit of the complications of intercostal chest drain insertion in a high volume trauma service in South Africa

Ensuring Basic Competence in Thoracentesis

Root Cause of Analysis of Peculiar Response of Pneumothorax to Chest Tube Drainage

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