Elsevier

Thoracic Surgery Clinics

Volume 27, Issue 1, February 2017, Pages 57-67
Thoracic Surgery Clinics

Errors and Complications in Chest Tube Placement

https://doi.org/10.1016/j.thorsurg.2016.08.009Get rights and content

Section snippets

Key points

  • Despite many benefits, drain placement is not always a harmless procedure, and potential significant morbidity and mortality may exist.

  • According to the guidelines, to reduce the risk of injury of the underlying vascular structures, the drain should be inserted within the so-called “safe triangle,” defined as the thoracic area between the anterior edge of the latissimus dorsi muscle, the lateral edge of the pectoralis major muscle, and a line superior to the horizontal level of the nipple with

Standard surgical techniques for chest drain placement

The standard technique to correctly insert a chest drain is extensively described by the British Thoracic Surgery (BTS) guidelines.4 Before proceeding to any invasive procedure, an exhaustive individual consent form, which explains the advantages and the possible complications of the surgical procedure, should be obtained from the patient and documented in the patient medical record.

The preferred patient’s position should be supine, on the bed, slightly rotated, with the arm placed behind the

Errors and complications in chest drain insertion

Complications of the tube thoracostomy procedure may be categorized as acute, chronic, procedural, and nonprocedural.8 The average complication rate after chest tube placement may vary between 5% and 10%.9 The most frequently reported problems are tube malposition, other technical complications (1%), empyema (1%–2%), and bronchopleural fistula (rare).8 Furthermore, any anatomic thoracic structure may be at risk during chest drainage insertion.

Although absolute contraindications to tube

Lung Injury

The most common intrathoracic organ that may be injured is the lung. Pulmonary lacerations are more frequent in those patients who underwent a previous thoracic surgery or pleurodesis, in whom a high risk of dense adhesions is expected.8 Particular care should be therefore taken in such patients and a careful thorough radiological examination is needed before chest tube insertion. Ultrasonography could be of great help to correctly delimitate pleural effusions before placing the tube. An

Injury of extrathoracic organs

Improper chest drain placement may result in an unintended intra-abdominal insertion; the incidence of such complication is very difficult to know, because most information is based on single case reports. The physicians should take care of the patient’s body habitus (severely obese patients are, for example, at higher risk for tube malpositioning) and previous possible surgical interventions that could result in diaphragm elevation.

Other complications

Less severe complications of tube thoracostomy are described in the following sections.

Summary

In conclusion, tube thoracostomy is one of the most common invasive procedures in hospitalized patients; correct indication, caliber, and proper insertion of the chest tube is of paramount importance. The surgical maneuver is not always devoid of complications, and potential significant morbidity and mortality may exist. Moreover, inappropriately positioned drains may be unapparent clinically in the short term, but may have serious outcomes in the long term. The use of ultrasonography has

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References (32)

  • E.W. Cameron et al.

    Computed tomography of malpositioned thoracostomy drains: a pictorial essay

    Clin Radiol

    (1997)
  • K.E. Lim et al.

    Diagnosis of malpositioned chest tubes after emergency tube thoracostomy: is computed tomography more accurate than chest radiograph?

    Clin Imaging

    (2005)
  • J.P. Cunningham et al.

    Is routine chest radiograph necessary after chest tube removal?

    J Pediatr Surg

    (2014)
  • T.B. Gilbert et al.

    Chest tubes: indications, placement, management, and complications

    J Intensive Care Med

    (1993)
  • D. Laws et al.

    BTS guidelines for the insertion of a chest drain

    Thorax

    (2003)
  • Available at: www.npsa.nhs.uk/alerts-and-directives/rapidrr/risks...
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      Although rare, injury to visceral organs or great vessels is one of the most serious complications and may warrant emergent surgical intervention. Ectopic insertion may injure any intrathoracic or intra-abdominal organ but the most commonly injured structures are the lung, heart, diaphragm, and great vessels.25 Table 2 lists complications, causes, signs/symptoms to monitor, and ways to prevent or intervene to correct.

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