Traumatic complications from placement of thoracic catheters and tubes

Abstract

The volume of critically ill patients requiring stabilization in emergency departments (EDs) throughout the USA has increased from 42 million per year in 1960 to over 92 million in 1990, as reported by Goldstein [Crit Care Clinics 21(1):81-89, 2005] and Rivers et al. [Curr Opin Crit Care 8(6):600-606, 2002]. With the increase in this patient population, the number of procedures, both invasive and noninvasive, performed in the ED to improve clinical outcomes has also increased. Therefore, emergency medicine physicians must add to their repertoire the ability to recognize potentially fatal traumatic complications. This review will provide readers with imaging findings of traumatic complications from placement of thoracic catheters and tubes and briefly discuss pitfalls of performing these procedures. In particular, complications arising from placement of hemodialysis catheters, central venous catheters, Swan-Ganz catheters, chest tubes, nasogastric and feeding tubes, and endotracheal tubes will be reviewed.

Comparison of the efficacy of small and large‐bore thoracostomy tubes for pleural space evacuation in canine cadavers

“…Due to the bloated peritoneal cavity of the cadavers it is possible that the diaphragm was distended cranially in the cadavers that led to an increased risk of perforating the diaphragm during placement. Hemorrhage, pulmonary contusions, visceral damage, and inadvertent placement into the abdominal cavity are reported complications of thoracostomy tube placement in clinical patients . In the authors’ opinion percutaneous placement of thoracostomy tubes without causing apparent pulmonary trauma was more difficult in these cadavers that lacked pleural space disease compared to clinical patients with pleural effusion or pneumothorax.…”

Initial and Ongoing Verification of Feeding Tube Placement in Adults (applies to blind insertions and placements with an electromagnetic device)

“…55,56 Radiographic Confirmation 1. A properly obtained and interpreted radiograph is recommended to confirm correct placement of any blindly inserted tube (small bore or large bore) before its initial use for feedings or medication administration 1,11,[57][58][59][60][61][62][63] ; the same recommendation applies to a tube inserted with assistance from ETP device. 52,53 Because radiographs may be misinterpreted, 39,45,58,64 it is best to have a radiologist interpret the film to approve use of the tube for feedings.…”

Iatrogenic emergency medicine procedure complications and associated trouble-shooting strategies

“…Iatrogenic injuries are an inevitable part of medicine. Emergent procedures performed in the emergency department (ED) present a higher risk for iatrogenic injury than in more controlled settings (Swain et al, 2005;Mort, 2004). Contributing factors include level of experience, frequency of the performed procedure, variations in human anatomy, fatigue and the time critical nature of life-saving procedures in the ED (Croskerry and Sinclair, 2001).…”