Chest drain insertion is not a harmless procedure--are we doing it safely? (original) (raw)
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Postgraduate medical journal, 2015
Intercostal chest drain (ICD) insertion is considered a core skill for the general physician. Recent guidelines have highlighted the risks of this procedure, while UK medical trainees have reported a concurrent decline in training opportunities and confidence in their procedural skills. We explored clinicians' attitudes, experience and knowledge relating to pleural interventions and ICD insertion in order to determine what changes might be needed to maintain patient safety and quality of training. Consultants and trainees delivering general medical services across five hospitals in England were invited to complete a questionnaire survey over a 5-week period in July and August 2014. 117 general physicians (32.4% of potential participants; comprising 31 consultants, 48 higher specialty trainees, 38 core trainees) responded. Respondents of all grades regarded ICD insertion as a core procedural skill. Respondents were asked to set a minimum requirement for achieving and maintaining ...
Journal of surgical education, 2015
To review the ability of junior doctors (JDs) in identifying the correct anatomical site for intercostal chest drain insertion and whether prior Advanced Trauma Life Support (ATLS) training influences this. We performed a prospective, observational study using a structured survey and asked a group of JDs (postgraduate year 1 [PGY1] or year 2 [PGY2]) to indicate on a photograph the exact preferred site for intercostal chest drain insertion. This study was conducted in a large metropolitan university hospital in South Africa. A total of 152 JDs participated in the study. Among them, 63 (41%) were men, and the mean age was 24 years. There were 90 (59%) PGY1 doctors and 62 (41%) PGY2 doctors. Overall, 28% (42/152) of all JDs correctly identified the site that was located within the accepted safe triangle. A significantly higher proportion of PGY2 doctors selected the correct site when compared with PGY1 doctors (39% vs 20%, p = 0.026). Those who had prior ATLS provider training were 6.8...
Chest drain care bundle: Improving documentation and safety
BMJ Quality Improvement Reports, 2015
Chest drain insertion is a common advanced procedure with a significant associated risk of pain, distress, and complications. Nationally, audit and recommendations from leading bodies have highlighted a number of safety concerns around chest drain insertion. Audit work has demonstrated poor levels of documentation; particularly around use of premedication, use of ultrasound guidance and consent. This has obvious potential consequences for patient safety and thus is an important target for improvement work. This project quantifies current standards of documentation and aims to improve this through a combination of accessible and easy to read guidelines, education, and the introduction of a chest drain insertion bundle. National best practice standards were identified through review of national guidance. Drain insertion was prospectively analysed over a three month period to establish baseline standards of documentation. This initial work was presented and a bundle and clinical guidelines produced. Chest drain insertion was then reaudited and assessed for improvement. Results demonstrated an improvement in many areas of documentation, pushing local results above the national average. However, only 40% of cases used the new bundle due to a mixture of staff rotation and an unexpectedly high proportion of drains inserted in non targeted areas including the emergency department, theatre, and intensive care. Despite this, the introduction of accessible guidance and bundle has significantly improved chest drain insertion documentation to the benefit of all.
Chest drains: prevalence of insertion and ICU nurses’ knowledge of care
Heliyon, 2021
Background: Even though literature revealed the problem of nurses' knowledge deficit regarding the care of chest drain in general, no study that investigated the prevalence of chest drains in ICUs and nurses' knowledge of chest drain among Jordanian nurses was found in the literature. This study aims were to describe the prevalence rate of chest drain insertion in Jordanian ICUs, and to evaluate Jordanian nurses' level of knowledge regarding chest drain care. Methods: Anon-experimental descriptive design using cross-sectional survey was used for evaluating nurses' knowledge utilizing researchers-developed instrument. In addition, a retrospective chart review for patients who had chest drain in the previous three months to assess the prevalence rate of chest drain insertion. Data was analysis using the Statistical Package for Social Sciences (SPSS) program. Results: The 3-month period prevalence of chest drain insertion was 8%. The most common indication for chest drains insertion was cardiac surgery (84.8%, n ¼ 134) followed by pleural effusion (6.3%, n ¼ 10). The results revealed that the mean score for nurses' knowledge regarding care of chest drain was 15.7 out of 30 (52.3%), with the majority had insufficient or intermediate level of knowledge (47.6%, n ¼ 107 vs. 51.1%, n ¼ 115). The areas with least level of knowledge were in the troubleshooting (31.9%), and removal (39.5%). Nurses from private hospitals had significantly higher (M ¼ 16, SD AE 2.77) level of knowledge (F[2, 222] ¼ 8.467, p < .001) than nurses from other sectors. Conclusions: Chest drain is prevalent in Jordanian ICUs, which requires nurses to know how to care for patients with this critical intervention. However, they seemed to lack the needed knowledge for the appropriate care. Developing, implementing and continuous monitoring of guidelines regarding chest drain care for nurses and physicians are recommended.
Nurses’ Knowledge Levels of Chest Drain Management: A Descriptive Study
Eurasian Journal of Pulmonology, 2017
INTRODUCTION Chest drainage is defined as discharging air, water, blood, and other fluids by inserting a tube into the pleural or mediastinal cavity. Chest drainage is generally used in the treatment of patients who have undergone heart and chest surgery or chest trauma (1). Chest drainage is an invasive operation; insufficient knowledge and experience of the healthcare team may lead to unwanted complications (2). The mismanagement of chest drainage may cause series of complications such as increased morbidity, extension of duration of hospital stay, and even death in some cases (3). The insertion of a chest tube in a patient using the aseptic technique is the physician's responsibility. However, as long as the chest tube is kept inserted, the nurses' responsibilities include (i) monitoring the drainage bottle and suction level, (ii) recording the quantity and content of drainage, (iii) administering wound care and follow-up of pain, and (iv) providing information and support to the patient (4). The applications involving these aspects of nursing in the management of patients with chest tubes are inconsistent, which leads to distrust regarding nurses during patient care (5).
Management of chest drains: A national survey on surgeons-in-training experience and practice
Nigerian Journal of Surgery, 2015
Thoracic trauma and many pleural diseases are commonly treated with tube thoracostomy. On account of its vast clinical utility, the procedure has become a mandatory skill not only for surgeons, but also for intensivists and emergency physicians. [1] However, tube thoracostomy is not without its own complications. [2] Early and late complications have been shown to be as low as 3% and 8% respectively in trained hands. [3] Hence, we undertook this study to ascertain the level of experience and expertise of surgeons-in-training in Nigeria in performing tube thoracostomy safely. MAterIAls And Methods Accredited Departments of Surgery in four university hospitals in Nigeria were selected for the study by simple random sampling.
A regional survey of chest drains: evidence-based practice?
Postgraduate Medical Journal, 1999
Summary Although the use of chest drains is common in medicine, there appear to be wide variations in practice. A survey was therefore conducted to establish the current status of chest drain management in the Northwest region. A questionnaire targeted consultants practising in the specialties of chest medicine, general surgery, accident & emergency and cardiothoracic surgery. The questionnaire consisted of five sections encompassing aspects of the insertion, day-to-day care and removal of chest drains. With an overall response rate of 75.3% (110/146), important variations in every major aspect of the practice of chest drains were found between the specialties and to a large extent within each specialty. We have made a number of recommendations which aim to encourage good practice and reduce unnecessary complications, including the adoption of standardised protocols for inserting and managing chest drains.
Nurses’ knowledge of chest drain care: an exploratory descriptive survey
Nursing in Critical Care, 2005
Chest drains are a common feature of patients admitted to acute respiratory or cardio-thoracic surgery care areas. Chest drains are either inserted intraoperatively or as part of the conservative management of a respiratory illness or thoracic injury. Anecdotally, there appears to be a lack of consensus among nurses on the major principles of chest drain management. Many decisions tend to be based on personal factors rather than sound clinical evidence. This inconsistency of treatment regimes, together with the lack of evidencebased nursing care, creates a general uncertainty regarding the care of patients with chest drains. This study aimed to identify the nurses' levels of knowledge with regard to chest drain management. The research objective of this study was to describe the nurses' levels of knowledge regarding the care of the patient with chest drains. The data were collected using survey method. The results of the study revealed deficits in knowledge in a select group of nurses. Several service-led options exist with regard to improving knowledge in this area, such as service study days as well as ward-based tutorials. However, in an era of increasing accountability together with the impetus for each nurse to provide evidence-based care, it is crucial for individual nurse responsibility in the pursuit of knowledge in this area. Nurses must be supported by local practice development and through personal portfolio use to identify gaps in knowledge and seek appropriate training and resources.
Annals of The Royal College of Surgeons of England, 2014
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).
Factors affecting the safety of drains and catheters in surgical patients
Turkish Journal of Surgery, 2014
Objective: Drains and catheters are used for both prophylactic and therapeutic reasons in clinical practice. This study aimed to investigate the factors that affect safety of drains, catheters, nasogastric tube and central venous line in patients who underwent surgery. Material and Methods: Two hundred and four consecutive patients who were operated at the general surgery clinics under general anesthesia were included in the study. Factors that affect the safety of drains and catheter were followed and recorded prospectively. Results: During follow-up period, 12 (5.8%) patients have experienced problems regarding safety of drains/catheters. The mean age of patients who were followed-up in terms of security problems was 63.1 (39-86) years. Eight (66.7%) patients had been operated emergently, and four (33.3%) patients electively. Three (25%) patients had psychiatric/neurological co-morbidities and 3 (25%) patients were confused due to anesthesia/intensive care unit treatment when the drain safety was broken. Eight (66.7%) patients withdrew the drains or catheters by themselves, in 2 (16.7%) patients the drains spontaneously came out and in 2 (16.7%) patients the wrong drain was withdrawn. One patient had dementia, one patient had Alzheimer's disease and one patient was being followed-up with a diagnosis of schizophrenia. In three (25%) patients the abdominal drain, in four (33.3%) patients nasogastric tube, in one (8.3%) patient intubation tube, in one (8.3%) patient central venous catheter, and in three (25%) patients multiple drains were removed. Conclusion: The inaccurate use of drains or re-intervention for an unintentionally removed drain causes problems regarding patient safety. Close monitoring of surgical patients in terms of security, and submission of additional measures for patients with confusion and neurological/psychiatric disorders are of great importance.