Complications after Thoracocentesis and Chest Drain Insertion: A Single Centre Study from the North East of England

Abstract

Introduction: There are no prospective studies looking at complications of pleural procedures. Previous British Thoracic Society Pleural audits and retrospective case series inform current practice. Incidence of any complication is between 1–15%. We sought to add to the existing literature and inform local practice with regards to intercostal drains and thoracocenteses. Methods: Local Caldicott approval was sought for a review of all inpatient adult pleural procedures coded as ‘T122 drainage of pleural cavity’ and ‘T124 insertion of tube drain into pleural cavity’. Those undergoing thoracocentesis (all with a Rocket 6 Fg catheter) and intercostal drain insertion (ICD, all with Rocket 12 Fg drain) were identified. Continuous variables are presented as mean (±range) and categorical variables as percentages where appropriate. Results: 1159 procedures were identified. A total of 199 and 960 were done for pneumothorax and effusions respectively. Mean age was 68.1 years (18–97). There were 280 thoracocenteses and 879 ICDs. Bleeding occurred in 6 (0.5%), all ICDs (clotting and platelets were within normal range; one patient was on aspirin and one on aspirin and clopidogrel). All settled except for one who had intercostal artery rupture needing cardiothoracic intervention (no anti-coagulation). Nine pneumothoraces occurred (0.78%) in seven ICDs and two aspirations). There were three definite pleural space infections (0.3%) with three ICDs. Fall out rates for ICDs were 35 (3%). Nine were not sutured, and out of those, seven inserted in the Accident and Emergency department, out of hours. All others ‘came out’ due to patient factors (previous quoted rates up to 14%). Surgical emphysema occurred in 43 (41 ICDs), 3.7%. Eight were due to fall outs and three required surgical intervention. There was no re-expansion pulmonary oedema nor direct deaths. Conclusions: Complication rates of ICD and thoracocenteses are low. Checklists might help to remind operators of the need for suturing. Limitations of this study are its retrospective nature and reliance on correct hospital coding. We are currently contributing to a prospective observational study on pleural complications.

Risk Factors and Incidence of Pneumothorax After Ultrasound-Guided Thoracentesis

“…A previous study suggested that pleural pressure decreases significantly with removing a large volume of pleural fluid; visceral pleura may rupture and cause a pneumothorax (Shimoda et al, 2021). In the current study, bilateral procedures increased the risk of pneumothorax, unlike a previous study, which did not report any association between bilateral function and pneumothorax (Jackson et al, 2021).…”

Pulmonary and intestinal tuberculosis with COVID-19 complicated with fluidopneumothorax and colovesical fistula: The importance of diagnosis complexity in line with clinical setting

“…In countries with a high prevalence of TB, a ruptured cavity of TB can be a cause of pneumothorax or hydropneumothorax. Hydropneumothorax can be diagnosed according to pleural fluid analysis, pleural fluid culture, CXR, or thorax CT scan [33] . Thorax CT scan is important for etiological diagnosis because it is easier and faster than pleural fluid analysis, therefore it can be used as an initial examination.…”

“…An intercostal drain (ICD) device is inserted for drainage. In cases with TB etiology, ICD insertion may take longer, up to 30 days [33] .…”

Pleural procedures: an audit of practice and complications in a regional Australian teaching hospital

“…Comparison of complication rates is limited because of a lack of prior studies reporting pleural procedure complication rates. Only one British single‐centre study, by Jackson et al ., 15 reported the majority of complications contained in the BTS audits, with an 8% overall complication rate. Future audits should aim to report the same complications to allow for direct comparisons.…”