Complications and pitfalls of Tube Thoracostomy at a Tertiary Care Hospital

Abstract

Background: A significant number of patients are treated by doctors in the emergency room due to the rising incidence of catastrophic chest injuries. For the treatment of pneumothorax, hemothorax, and hemopneumothorax resulting from chest trauma, a tube thoracostomy is a vital life-saving procedure. This study was conducted to outline potential issues with Thoracostomy tube insertion and typical pitfalls in managing the underwater seal system. Objective: To outline potential issues with Thoracostomy tube insertion and typical pitfalls in managing the underwater seal system. Methodology: This retrospective study was carried out at the General / Thoracic Surgery Department of Hayatabad Medical Complex Peshawar between July 2019 and June 2021. A total of 300 patients were included in this study. Complications related to the thoracostomy tube insertion and mistakes practised by the medical staff regarding the management of the thoracostomy tube and its system were documented and analyzed. Results: There were 22 (7.3%) complications related to tube insertion, 13 (4.3%) iatrogenic lung injuries occurred during the insertion process, followed by diaphragmatic injuries 4 (1.3%), intercostal vessel injury 3 (1%) & liver injury 2 (0.7%) respectively. There were total 118 (39.3%) pitfalls were observed, amongst which the most common was clamping the chest tube 29 (9.7%), followed by intrathoracic malposition 22 (7.3%), loose fixation 18 (6%), improper handling of suction system 15 (5%), vent covering 12 (4%), improper filling of the bottle 9 (3%), subcutaneous position 7 (2.3%), improper insertion site 6 (2%) respectively.  Conclusion: The trocar was the cause of all chest tube insertion-related issues. It is common to make mistakes when working with the tube and its system. All surgeons, especially general surgery residents and paramedical staff should complete specialised training in chest tube management and care.