A novel and safe technique in closed tube thoracostomy (original) (raw)
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Tube Thoracostomy: Complications and Its Management
Pulmonary Medicine, 2012
Background. Tube thoracostomy is widely used throughout the medical, surgical, and critical care specialities. It is generally used to drain pleural collections either as elective or emergency. Complications resulting from tube thoracostomy can occasionally be life threatening.Aim. To present an update on the complications and management of complications of tube thoracostomy.Methods. A review of the publications obtained from Medline search, medical libraries, and Google on tube thoracostomy and its complications was done.Results. Tube thoracostomy is a common surgical procedure which can be performed by either the blunt dissection technique or the trocar technique. Complication rates are increased by the trocar technique. These complications have been broadly classified as either technical or infective. Technical causes include tube malposition, blocked drain, chest drain dislodgement, reexpansion pulmonary edema, subcutaneous emphysema, nerve injuries, cardiac and vascular injurie...
Analysis of 200 Cases of Tube Thoracostomies Performed by General Surgeons
2014
OBJECTIVE OF STUDY: To observe various indications & complications of tube Thoracostomy. DESIGN: Prospective, descriptive study. PLACE &DURATION OF STUDY: Public and private sector hospitals of Nawabshah and Hyderabad from 1st Jan 2005 to Dec 2008. METHODOLOGY: All patients of either sex above the age of 13 years having pathology related to chest cavity and underwent chest intubation were included in the study. Patients below the age of 13 years, having serious co morbid illness like Ischemic heart disease (ASA-3), severe chronic obstructive airway disease requiring ventilator support, and complicated chronic liver disease & patients who lost to follow-up were excluded. Data was collected for age, sex, indications of chest intubations, cause of the disease, procedural and post procedural complications & hospital stay. Descriptive analysis was performed using SPSS version 10 for continuous and frequency variables. RESULTS: Total 200 patients of different pathologies related to chest ...
Thoracostomy tubes: A comprehensive review of complications and related topics
International Journal of Critical Illness and Injury Science, 2014
Tube thoracostomy (TT) placement belongs among the most commonly performed procedures. Despite many benefits of TT drainage, potential for significant morbidity and mortality exists. Abdominal or thoracic injury, fistula formation and vascular trauma are among the most serious, but more common complications such as recurrent pneumothorax, insertion site infection and nonfunctioning or malpositioned TT also represent a significant source of morbidity and treatment cost. Awareness of potential complications and familiarity with associated preventive, diagnostic and treatment strategies are fundamental to satisfactory patient outcomes. This review focuses on chest tube complications and related topics, with emphasis on prevention and problem-oriented approaches to diagnosis and treatment. The authors hope that this manuscript will serve as a valuable foundation for those who wish to become adept at the management of chest tubes.
Indications and complications of tube thoracostomy performed by general surgeons
2008
The operating theater is a unique learning environment where surgical residents acquire technical skills, knowledge and confidence; the essentials of the craft of surgery. [1,2] Surgical skills are learnt by trainees through an apprenticeship system, where consultants act as guides to trainees rotating through their units within a set period of time. [3,4] A combination of teaching methods including supervised exposure to graded operative experience and didactic with feedback sessions imparts knowledge and technical skills. [3,5-7] The challenge for the trainer has always been the translation of these tenets into practice. [4] Surgery is different compared with other medical disciplines as it requires the development of a physical craft with cognitive growth. [1] Accuracy, speed, economy of effort and adaptability are determinants of surgical skill. Thus, coordination of actions, time and motion efficiency and the ability to provide assistance or make use of assistance appropriately are important factors in surgical handicraft. [7] In addition, learning surgical procedures requires mental assimilation of new information and its accommodation with existing evidence based knowledge. [8] Residents must take in myriads of information including, but not limited to selection of operation, patient positioning, anatomic and technical aspects of the operation and interaction with the operating theater team. [9] Furthermore, the operating theater is often a stressful environment with a background of distractions. [5] These include concerns about time management (e.g., patient cancellation), availability of resources (e.g., equipment allocation), roles (e.g., responsibilities), patient safety and sterility (e.g., aseptic
TURKISH JOURNAL OF MEDICAL SCIENCES, 2016
Background/aim: The collection of fluids, blood, pus, or air in the pleural cavity is a pathological condition requiring pleural drainage. A newly designed thorax drainage catheter in the prototype phase was used in this experimental study to test its efficacy. Materials and methods: A hemopneumothorax was first caused by a penetrating injury on the frontal axis of the sixth intercostal space on the right hemithorax with a scalpel on 6 female Sus domesticus swine subjects. After resting for 5 min, a tube or catheter was inserted. The same procedure with a tube thoracostomy or thorax drainage catheter was repeated on the left hemithorax. The time periods were recorded. After all procedures were completed, the thoracic organs were assessed for iatrogenic injuries. Results: In terms of time elapsed for procedure, statistically significant differences between the tube thoracostomy and thorax drainage catheter applications were identified (P < 0.05). Additional iatrogenic injuries were nonexistent for both groups. During the thorax drainage catheter application, a surgical set or the use of sutures was not required. Conclusion: This study showed promising results regarding the efficacy of the thorax drainage catheter for convenient use in prehospital and hospital settings by physicians with little experience with tube thoracostomy.
SBMU publishing, 2017
Introduction: Tube thoracostomy complications depend on the operator's skill, patients' general condition and the place in which the procedure is done. The present study aimed to compare the quality and complications of tube thoracostomy carried out by emergency medicine residents (EMRs) and surgery residents (SRs). Methods: This cohort study was conducted on 18-60 years old trauma patients in need of tube thoracostomy presenting to two academic emergency departments. Quality of tube placement and its subsequent complications until tube removal were compared between SRs and EMRs using SPSS 20. Results: 72 patients with the mean age of 37.1±14.1 years were studied (86.1% male). 23 (63.8%) cases were complicated in SRs and 22 (61.1%) cases in EMRs group (total= 62.5%). Chest drain dislodgement (22.2% in SRs vs. 22.2% EMRs; p>0.99), drainage failure (19.4% in SRs vs. 16.7% EMRs; p=0.50), and surgical site infection (11.1% in SRs vs. 19.4% EMRs; p=0.25) were among the most common observed complications. The overall odds ratio of complication development was 0.89 (95% CI: 0.35-2.25, p = 0.814) for SRs and 1.12 (95% CI: 0.28-4.53, p = 0.867) for EMRs. Conclusion: The findings of the present study showed no significant difference between SRs and EMRs regarding quality of tube thoracostomy placement and its subsequent complications for trauma patients. The rate of complications were interestingly high (>60%) for both groups.
International Journal of Cardiovascular and Thoracic Surgery
Background: The most commonly performed surgical procedure in thoracic surgery is Tube thoracostomy. General surgeons, intensivists, emergency physicians, and respiratory physicians may at one time or the other be required to perform tube thoracostomy as a lifesaving procedure. Objective: To observe experience of tube thoracostomy under thoracic surgery unit of BSMMU,
The analysis of 89 patients that performed tube thoracostomy by general surgeons
Turkish Journal of Surgery, 2017
of 89 patients who underwent tube thoracostomy performed by general surgeons Objective: Death due to thoracic trauma accounts for 20% of all trauma deaths. The aim of this study was to discuss the approach applied by general surgeons to thoracic trauma in our center. Material and Methods: A total of 89 patients (82 male, 7 female; mean age: 26.8 years; range: 7 to 77 years) with thoracic trauma who were admitted to the emergency department and underwent thoracostomy performed by general surgeons between January 2008 and December 2013 were retrospectively analyzed. Results: Penetrating trauma was found in 61 patients (68%); this was the most common cause of thoracic trauma. Pneumothorax, the most common clinical sign, was found in 57 patients (64%). Abdominal pathologies, the most common concomitant extra-thoracic pathologies, were found in 17 patients (19%). Fifteen patients (17%) underwent laparotomy due to intra-abdominal organ injuries. Splenic trauma and diaphragmatic injury were detected in five patients. Complications were seen in two patients (2.2%): one had an air leak and one had persistent pneumothorax. Three patients with multi-trauma died in the early period due to additional pathologies. No mortality was seen in any patient due to thoracic trauma. Conclusion: All general surgeons should be highly familiar with approaches to thoracic trauma, and necessary interventions should be performed in emergency situations. It is also essential to correctly identify patients who require timely and appropriate referral to a tertiary center to reduce the rates of mortality and morbidity.
Introduction: Tube thoracostomy complications depend on the operator's skill, patients' general condition and the place in which the procedure is done. The present study aimed to compare the quality and complications of tube thoracostomy carried out by emergency medicine residents (EMRs) and surgery residents (SRs). Methods: This cohort study was conducted on 18-60 years old trauma patients in need of tube thoracostomy presenting to two academic emergency departments. Quality of tube placement and its subsequent complications until tube removal were compared between SRs and EMRs using SPSS 20. Results: 72 patients with the mean age of 37.1±14.1 years were studied (86.1% male). 23 (63.8%) cases were complicated in SRs and 22 (61.1%) cases in EMRs group (total= 62.5%). Chest drain dislodgement (22.2% in SRs vs. 22.2% EMRs; p>0.99), drainage failure (19.4% in SRs vs. 16.7% EMRs; p=0.50), and surgical site infection (11.1% in SRs vs. 19.4% EMRs; p=0.25) were among the most co...
Analysis of Tube Thoracostomy Performed by Pulmonologists at a Teaching Hospital
Chest, 1997
To evaluate all tube thoracostomies (TTs) done by pulmonary/critical care fellows and attending physicians in the Medical University of South Carolina's health-care system documenting patient demographics, indication for placement, size and characteristics of the tube, and associated problems. Design: Prospective. Setting: University health-care system, including a university hospital, a Veterans Affairs hospital, and a county hospital. Patients: All adult patients requiring consultation by a member of the pulmonary/critical care staff for a tube thoracostomy. Results: One hundred twenty-six tube thoracostomies were performed over a 24-month period in 91 patients. The most common initial indication for a TT was pneumothorax (69/103, 67%). Overall mortality in the patient population was 35% (32/91). Early problems (<24 hours following placement) occurred in 3% (4/126); late problems (>24 h after placement) occurred in 8% (10/126). Problems occurred in 36% (4/ll) of small-bore tube placements vs 9% (10/ll5) of standard TT placements (p=0.02). Conclusions: Tube thoracostomy can be safely performed by pulmonologists with relatively few associated problems.