An unusual complication of chest tube thoracostomy

Abstract

This paper describes a previously unreported complication of chest tube thoracostomy: scalpel blade dislodgement within the pleural space. Techniques and complications of chest tube thoracostomy are then discussed. RÉSUMÉ :Le présent article décrit le cas d'une complication non signalée jusqu'à présent d'un déplacement dans l'espace pleural de la lame de scalpel utilisée pour une thoracotomie. Les techniques et les complications de la thoracotomie sont ensuite discutées. CASE REPORTS • OBSERVATIONS An unusual complication of chest tube thoracostomyHugo Poncia, MD;* John M. Ryan, MD † Case reportAn obese 67-year-old man with asthma, angina and hypertension presented to the emergency department (ED) complaining of having had a "cold" for 2 days, wheezing for 18 hours and experiencing acute shortness of breath that began 2 hours prior to presentation. On examination, he was diaphoretic and had difficulty speaking. Vital signs included a respiratory rate of 33 breaths/min, pulse of 100 beats/min and blood pressure of 224/119 mm Hg. Oxygen saturation was 88% on room air and improved to 94% with 60% mask oxygen. There was audible wheezing, a tracheal tug and intercostal recession. Peak expiratory flow rate was 100 L/min and arterial blood gas analysis revealed a pH of 7.31, a PCO 2 of 59.3 mm Hg and a PO 2 of 95.6 mm Hg.

Guidelines for chest drain insertion may not prevent damage to abdominal viscera

“…Some quote the level of the nipple as being, for example, in the fourth24 or fifth intercostal space 3 23. However, this is variable within and between individuals depending on gender, body position, adiposity and age.…”

Life Threatening Hemoperitoneum and Liver Injury as a Result of Chest Tube Thoracostomy

“… 9 An effective method is to place the skin incision in the fifth or sixth intercostal space, and then tunnel up over the rib and insert the tube through the next higher interspace. 9 …”

“…8 CTT-induced intra-abdominal organ injury can be prevented by the use of a high approach and insertion of the chest tube at or above the inter-mammary line in the fourth or fifth intercostal space. 9 An effective method is to place the skin incision in the fifth or sixth intercostal space, and then tunnel up over the rib and insert the tube through the next higher interspace. 9 In conclusion, CTT is one of the frequently performed bedside procedures.…”

Cerebral Air Embolism Following Pigtail Catheter Insertion for Pleural Fluid Drainage

“…The complications of chest tube insertion include pneumothorax, hemothorax, pain, infection, dislodgement, kinking, disconnection of the chest tube, and drainage blockage8,9. Visceral organ injuries by the insertion procedure are rare, but fatal.…”