Complications of tube thoracostomy for chest trauma

ABSTRACT Objective: An audit was performed to describe the insertional and positional complications commonly encountered during the placement of intercostal chest drains for trauma. In addition, we sought to establish whether further training is warranted in those operators inserting intercostal chest drains outside of the level 1 trauma unit setting. Methods: Over a 3 month period all patients with or without a chest drain in situ who were assessed in the front room trauma bay of Tygerberg Hospital were included. Patients admitted directly through the trauma resuscitation unit were excluded from the audit. No long term infective complications were included. A self reporting system to record the complications was used and additional data was retrieved by a hand search of the department’s admission records and monthly statistics. Results: A total of 3989 patients were assessed in the trauma bay over the 3 month period. A total of 273(6.8%) patients with an intercostal chest drain/s in situ or requiring an intercostal drain/s were assessed in the trauma unit and admitted into the chest drain ward. In total 24 patients were identified with 26 complications relating to the insertion and positioning of the chest drains. 22(92%) of these were patients referred in with an intercostal chest drain in situ. An overall complication rate of 9.5% was seen. Insertional complications comprised 8(27%) with 19(73%) positional complications. The results show that the most common errors encountered were insertion at the incorrect anatomical site, extrathoracic placement and placement that was too shallow (with the side portal of the intercostal chest drain lying outside the chest cavity). Conclusion: The results suggest that operators at the referral hospitals have not received sufficient training in the technique of insertion of intercostal chest drains for chest trauma. These operators may benefit from more structured instruction and closer supervision of chest drain insertion. Conflict of interest: None declared