Complications of Tube Thoracostomy Placement in the Emergency Department

Sethuraman, Kinjal N.; Duong, David; Mehta, Supriya D.; Tara,; Crawford, Darcey; George, Jill; Rathlev, Niels K.

doi:10.1016/j.jemermed.2008.06.033

Cited by 48 publications

(41 citation statements)

References 10 publications

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“…ATLS ® training has standardised the teaching of ICD insertion and the technique described is regarded currently as the gold standard in terms of safety. 6 Despite the widespread adoption of ATLS ® training and principles as part of both undergraduate and postgraduate training worldwide, there continues to be a steady stream of literature reporting an unacceptably high rate of complications [1][2][3] and even mortality 5 associated with the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…However, the procedure is associated with a complication rate that may be as high as 30%. [1][2][3] Numerous case reports have documented individual cases of fatal complications such as ventricular perforation 4 and pulmonary artery injury following ICD insertion. 5 In light of this, the correct safe technique of insertion is one of the core skill sets that is heavily emphasised in the Advanced Trauma Life Support ® (ATLS ® ) course.…”

mentioning

confidence: 99%

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An audit of the complications of intercostal chest drain insertion in a high volume trauma service in South Africa

Kong

Oosthuizen

Sartorius

et al. 2014

annals

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INTRODUCTION Intercostal chest drain (ICD) insertion is a commonly performed procedure in trauma and may be associated with significant morbidity. METHODS This was a retrospective review of ICD complications in a major trauma service in South Africa over a four-year period from January 2010 to December 2013. RESULTS A total of 1,050 ICDs were inserted in 1,006 patients, of which 91% were male. The median patient age was 24 years (interquartile range [IQR]: 20-29 years). There were 962 patients with unilateral ICDs and 44 with bilateral ICDs. Seventy-five per cent (758/1,006) sustained penetrating trauma and the remaining 25% (248/1006) sustained blunt trauma. Indications for ICD insertion were: haemopneumothorax (n=338), haemothorax (n=314), simple pneumothorax (n=265), tension pneumothorax (n=79) and open pneumothorax (n=54).Overall, 203 ICDs (19%) were associated with complications: 18% (36/203) were kinked, 18% (36/203) were inserted subcutaneously, 13% (27/203) were too shallow and in 7% (14/203) there was inadequate fixation resulting in dislodgement. Four patients (2%) sustained visceral injuries and two sustained vascular injuries. Forty-one per cent (83/203) were inserted outside the 'triangle of safety' but without visceral or vascular injuries. One patient had the ICD inserted on the wrong side. Junior doctors inserted 798 ICDs (76%) while senior doctors inserted 252 (24%). Junior doctors had a significantly higher complication rate (24%) compared with senior doctors (5%) (p<0.001). There was no mortality as a direct result of ICD insertion. CONCLUSIONS ICD insertion is associated with a high rate of complications. These complications are significantly higher when junior doctors perform the procedure. A multifaceted quality improvement programme is needed to improve the situation.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

An audit of the complications of intercostal chest drain insertion in a high volume trauma service in South Africa

Kong

Oosthuizen

Sartorius

et al. 2014

annals

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“…Indeed, some international guidelines have published statements refuting the ability of thoracic US to image the intercostal vessels [4]. As such, bleeding from a lacerated ICA or ICA pseudoaneurysm continues to be a rare but serious complication [15,16,17,18]. …”

Section: Introductionmentioning

confidence: 99%

Thoracic Ultrasound Demonstrates Variable Location of the Intercostal Artery

et al. 2012

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Background: Ultrasound (US) guidance is advocated to reduce complications from thoracocentesis or intercostal catheter (ICC) insertion. Although imaging of the intercostal artery (ICA) with Doppler US has been reported, current thoracic guidelines do not advocate this, and bleeding from a lacerated ICA continues to be a rare but serious complication of thoracocentesis or ICC insertion. Objectives: It was the aim of this study to describe a method to visualise the ICA at routine US-guided thoracocentesis and map its course across the posterior chest wall. Method: The ICA was imaged in 22 patients undergoing US-guided thoracocentesis, at 4 positions across the back to the axilla. Its location, relative to the overlying rib, was calculated as the fraction of the intercostal space (ICS) below the inferior border of that rib. Results: An ICA was identified in 74 of 88 positions examined. The ICA migrated from a central ‘vulnerable’ location within the ICS near the spine (0.28, range 0.21–0.38; p < 0.001) towards the overlying rib (0.08, range 0.05–0.11; p < 0.001) in the axilla. Conclusions: The ICA can be visualised with US and is more exposed centrally within the ICS in more posterior positions; however, there is a marked variation between individuals, such that the ICA may lie exposed in the ICS even as far lateral as the axilla. Future studies need to identify which patients are at risk for a ‘low-lying’ ICA to further define the role of US imaging of the ICA during thoracocentesis or ICC insertion.

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“…Literatürde tüp torakostomi uygulanması ve izleminde görülen morbidite oranları %6-43 arasında değiş-mektedir (11)(12)(13)(14)(15) . Çalışmamızda ise bu oran %21,4 olup, literatürle uyumludur.…”

Section: Discussionunclassified

“…Çalışmamızda prosedür acil tıp uzmanları, göğüs cerrahları ve çocuk cerrahları tarafından uygulanmış- Tüp torakostomi işlemi, uygulayıcının beceri ve pratiğine, kullanılan tekniğe ve kişinin torakostomi gereksiniminin mekanizmasına göre başarısı ve komplikasyon oranı değişen bir prosedürdür. Literatürde komplikasyon oranları değişkenlik gös-termekle beraber %1-40 arasında bulunmuştur (13,21) . Çalışmamızda, olguların %21,4'ünde komplikasyon gelişmiştir.…”

Section: Discussionunclassified