COMPLICATIONS AND PITFALLS OF TUBE THORACOSTOMY AT A TERTIARY CARE HOSPITAL

Main Article Content

Shafi Muhammad khuhawar
Jagdesh Kumar
Khalil Ahmed Sanghro
Bashir Ahmed Chandio
Murk kukreja

Keywords

Complications, pitfalls, Tube Thoracostomy

Abstract

Background: A tube thoracostomy is an essential life-saving technique for the treatment of pneumonia, hemotopneumothorax, and hemopneumothorax arising from trauma to the chest


 


Objective; the aim of the study was to determine the Complications and pitfalls of Tube Thoracostomy at a Tertiary Care Hospital


 


Method and materials; this cross-sectional study was carried out at the department of Pulmonology, GMMMC hospital Sukkur. The study duration was six months From January 2023 to June 2023 after taking approval from the ethical committee of the institute. A total of 304 individuals were enrolled in this study who experienced a  drainage  technique  of  the pleural  cavity  by  a  thoracostomy  chest  tube. Chest tubes that were implanted at the cardiac center were excluded from the study. A chest X-ray was done after the tube was inserted, daily thereafter, and after it was removed. Done a CT scan of the chest if necessary. The thoracic surgical team monitored the chest tubes and their drainage system every day until the day of their removal. Any issues pertaining to the chest tube's insertion as well as any inaccuracies made in the maintenance and handling of the tube and its system were noted. The statistical analysis was carried out with SPSS 27.0 and the variable were expressed in the form of mean ± SD and percentages.


 


Results: A total of 304 individuals whose age was from 20-60 years were included in this study. Out of which 187 were male and 117 were females. 174 (57.2%) thoracostomy tubes were inserted in the operating room following thoracoscopic or open surgery; 92 (30.2%) went into the surgical and critical care units; 42 (13.8%) went into the emergency room. The most prevalent indication of thoracostomy tube insertion was post thoracotomy (52.9%).Tube insertion complications were 8.5%. The most common complication was iatrogenic lung injuries 4.6% followed by diaphragmatic injury 1.6% and injury of intercostal vessel 1.3% correspondingly. A  total 126  (41.4%)  pitfalls  were  detected, amongst  which  the  most  prevalent   was  clamping  the chest  tube  30 (9.8%),  tailed  by intrathoracic  malposition 23 (7.5%), loose fixation 19 (6.2%),  inappropriate handling  of  suction  system  16  (5.2%),  vent  covering  13 (4.2%), inappropriate filling of the bottle 10 (3.2%), subcutaneous position 7( 2. 6%) ,inappropriate insertion site 8 ( 2.6%) correspondingly.


 


Conclusion: The majority of the complications were brought on by the trocar-inserted chest tube. Therefore, inexperienced consultants ought to avoid from employing chest tubes with trocars.

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References

1. Ellis H. The applied anatomy of chest drain insertion. Br J Hosp Med. 2007; 68(Sup3):M44-5.
2. Remerand F, Luce V, Badachi Y, Lu Q, Bouhemad B, Rouby JJ. Incidence of chest tube malposition in the critically ill: a prospective computed tomography study. J Amer Soc Anesthesiolog. 2007; 106(6): 1112-9.
3. Sohara. Reexpansion pulmonary edema. Ann Thorac Cardiovasc Surg. 2008, 14(4), 205–9.
4. Sundaramurthy SR, Moshinsky RA, Smith JA. Nonoper at i ve management of tube thoracost omy induced pulmonary artery injury. Interact Cardiovasc Thorac Surg. 2009; 9(4):759-60.
5. Kao CL, Lu MS, Chang JP. Successful management of pulmonary artery perforation after chest tube insertion. J T rauma Acute Care Surg. 2007; 62(6): 1533.
6. Fry W, Paape K. Shield's text book of general thoracic surgery, 6 Ed. Chapter 56:794-805.
7. Ball C, Lord J, Laupland K, Gmora S, Mulloy RH, Nq AK, et al. Chest tube complications: How well are we training our residents? Can J Surg.2007; 50:450-58.
8. Edwin F. eComment: management options of tube thoracostomy-i nduced pul monary artery i nj ury. Interact Cardiovasc Thorac Surg. 2009; 9(4):760-1.
9. Gulati MS, Wafula J, Aggarwal S. Chilaiditi's sign possibly associated with malposition of chest tube placement. J. Postgrad. Med. 2008; 54(2):138.
10. Huber-Wagner S, Korner M, Ehrt A, Kay MV , Pfeifer KJ, Mutschler W. Emergency chest tube placement in trauma car e - Which approach is preferable? Resuscitation. 2007; 72:226-33
11. Dominguez Fernandez E, Neudeck F , Piotrowski J. Perforation of the heart wall—– a rare complication after thoracic drainage treatment. Chirurg. 1995; 66(9):920-2.
12. Rashid MA, Wikstrom T , Ortenwall P . Mediastinal perforation and contralateral hemothorax by a chest tube. Thorac Cardiovasc Surg. 1998; 46(6):375-6.
13. Cox PA, Keshishian JM, Blades BB. T raumatic arteriovenous fistula of the chest wall and lung Secondary to insertion of an intercostal catheter . J Thorac Cardiovasc Surg. 1967; 54(1):109-12.
14. Andrabi S, Andrabi SI, Mansha M, Ahmed M. An iatrogenic complication of closed tube thoracostomy for penetrating chest trauma. N Z Med J. 2007; 120(1264):U2784.
15. Dural K, Gulbahar G, Kocer B, Sakinci U. A novel and safe technique in closed tube thoracostomy. J Cardiothorac Surg. 2010; 5(1):1-4.
16. Monaghan SF, Swan KG. Tube thoracostomy: the struggle to the “standard of care”. Ann Thorac Surg. 2008; 86(6):2019-22.
17. Hutton I, Keenly H, Wong C. Using simulation models to teach junior doctors how to insert chest tubes: a brief and effective teaching module. Intern Med J. 2008:;[Epub ahead of print].
18. T ang A, Velissaris T , Weeden D. An evidence-based approach to drainage of the pleural cavity: evaluation of best practice. J Eval Clin Prac 2002;8: 333–40.
19. Fulbrook P. Developing best practice in critical care nursing: knowledge, evidence and practice. Nur Crit Care 2003; 8:96-102.
20. Lehwaldt D, Timmins F. Nurses' knowledge of chest drain care: an exploratory descriptive survey. Nur Crit Care 2005; 10:192-200

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