Computed tomography scan of the abdomen of a 47-year-old woman with a history of fatigue and malaise associated with nausea, vomiting, lower back pain and acute renal failure.See page 1029 for diagnoses.Three-dimensional reconstruction of a chest computed tomography scan of a 60-year-old woman with acute and chronic chest pain localized to the region of a 10-year-old thoracotomy scar.Computed tomography scan of the abdomen of an 87-year-old woman with 4-day history of fever, dysuria and left-flank pain.

IntroductionIntercostal tube drainage of pleural air or fluid is an essential tool in the management of respiratory patients. A common complication of drain insertion is accidental removal of the drain, usually as a result of inadequate securing techniques, with rates of up to 21% quoted in the literature.1,2 This often results in the need for further pleural procedures (including drain re-siting), with associated additional risk to the patient and an increase in health care costs. One suggested method to reduce premature drain removal is to use intercostal drains with ballooned tips. These would provide a relatively atraumatic physical obstruction to the thoracostomy site, whilst being easy to use as stitching or extensive taping may not be required.MethodsWe conducted a pilot study of a dedicated 16F ballooned intercostal drain (Rocket Medical; Figure 1) to assess its safety and feasibility, and to give an indication as to whether a reduction in accidental early drain removal could be achieved. Drains were inserted under ultrasound guidance using the Seldinger technique and secured with dedicated dressings. Skin sutures were not applied. Pain scores were collected from a subset of 11 patients using a visual analogue scale (VAS) from 0 (no pain) to 10 (worst pain imaginable) at insertion, 24h post-insertion, and drain removal to ensure pleural irritation was not prohibitive.ResultsTwenty patients requiring intercostal tube drainage as an in-patient for pleural effusion were recruited from a single hospital site. Of the drains inserted, 1/20 (5%) was prematurely dislodged., comparing favourably with the literature. Inspection of the device showed that the balloon had become partially unglued from the drain, hence deflation. The patient did not require further pleural procedures. No other drain-related adverse events were recorded. The drains were generally well tolerated, with median(range) pain scores at insertion, 24 hours, and removal of 1 (0–7), 3 (0–8), and 2 (0–7).ConclusionThe use of a dedicated ballooned intercostal drain is safe and feasible, and may reduce the need for drain re-siting. A larger randomised trial is planned.ReferencesCorcoran JP, et al. Pleural procedural complications: prevention and management. J Thorac Dis 2015;7(6):1058–67.Horsley A, et al. Efficacy and complications of small-bore, wire-guided chest drains. Chest 2006;130:1857–63.Abstract P15 Figure 1

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