Erosion into the subclavian artery by a chest tube

Thoracoacromial artery injury after tube thoracostomy for pneumothorax

In this case, a patient presented in a delayed fashion after blunt trauma is found to have a large left-sided pneumothorax, and tube thoracostomy is performed. After placement of the apically oriented tube, he developed haemothorax. CT imaging showed an area of questionable extravasation from the left subclavian artery, directly anterior to the thoracostomy tube. His haemothorax was refractory to adequate drainage with a new thoracostomy tube. He ultimately required angiography, coil embolisation and covered stent placement, followed by thoracoscopic evacuation of the haemothorax.

Misadventures of a Pigtail: Case Report of Accidental Insertion of a Chest Tube Into the Left Atrium During Interventional Radiology-Guided Placement

Chest tube thoracostomy is a commonly performed procedure in the emergency department, operating room, and intensive care unit. We report an extremely rare case of accidental insertion of a chest tube into the left atrium via the right pulmonary vein during an interventional radiology-guided placement of the catheter. To our knowledge, such a case has not been reported to date. The anesthetic and surgical management of this injury are discussed.

Comparison consequences of Jackson-Pratt drain versus chest tube after coronary artery bypass grafting: A randomized controlled clinical trial

Background:

Chest tubes are used in every case of coronary artery bypass grafting (CABG) to evacuate shed blood from around the heart and lungs. This study was designed to assess the effective of Jackson-Pratt drain in compare with conventional chest drains after CABG.

Materials and Methods:

This was a randomized controlled trial that conducted on 218 patients in Chamran hospital from February to December 2016. Eligible patients were randomized in a 1:1 ratio. Jackson-Pratt drain group had 109 patients who received a chest tube insertion in the pleural space of the left lung and a Jackson-Pratt drain in mediastinum, and Chest tube drainage group had 109 patients who received double chest tube insertion in the pleural space of the left lung and the mediastinum.

Results:

The incidence of pleural effusions in Jackson-Pratt drain group and chest tube group were not statistically different. The pain score at 2-h in Drain group was significantly higher than chest tube group (P = 0.001), but the trend of pain score between groups was not significantly different (P = 0.097). The frequency of tamponade and atrial fibrillation (AF) were significantly lower in Jackson-Pratt drain group (P < 0.05).

Conclusion:

The Jackson-Pratt drain is equally effective for preventing cardiac tamponade, pleural effusions, and pain intensity in patients after CABG when compared with conventional chest tubes, but was significantly superior regarding efficacy to hospital and Intensive Care Unit length of stay and the incidence of AF.

Is Traditional Closed Thoracic Drainage Necessary to Treat Pleural Tears After Posterior Approach Thoracic Spine Surgery?

STUDY DESIGN

A prospective study.

OBJECTIVE

The aim of this study was to evaluate the outcomes and efficacy of using a 10Fr elastic tube with a regular negative pressure ball to treat the operative pleural tear in the complicated single-stage posterior approach thoracic spine surgeries.

SUMMARY OF BACKGROUND DATA

In some complicated single-stage posterior approach thoracic spine surgeries, such as total en bloc spondylectomy, pleural tear is quite inevitable. Traditional chest tube with a water-sealed bottle has many shortcomings, as pain, inconvenience, and other complications. In many thoracic surgeries, a smaller-caliber elastic tube has been used to avoid such complications and achieve quick recovery. However, there are concerns about the efficacy and safety of the smaller-caliber elastic tube.

METHODS

A prospective trial was performed in 72 patients between April 2008 and March 2012. Pleural tear occurred in 19 patients, among whom 10 patients were inserted a 10Fr elastic tube with a regular negative pressure ball (Group I), and nine were inserted a 28Fr chest tube with a water-sealed bottle (Group II). Comparative evaluation of the clinical and radiographic data was carried out.

RESULTS

The basic condition of two groups did not differ significantly. The oxygen saturation monitor, hospital length of stay, average volume, and failure rate of drainage between two groups were not statistically significant. The difference of the visual analog score was significant (1.10 ± 0.35 vs. 3.89 ± 0.59, P < 0.001).

CONCLUSION

Patients who received a 10Fr elastic tube with a regular negative pressure ball experienced less pain and a tendency of quicker recovery than those who received a 28Fr chest tube with a water-sealed bottle. The complication rate in Group I was not higher than Group II, indicating an equally good drainage efficacy.

LEVEL OF EVIDENCE

2.

Complications of chest tubes: a focused clinical synopsis

PURPOSE OF REVIEW

Chest tube placement, or tube thoracostomy, is an invasive procedure designed to evacuate air and/or fluid from the thorax, whether emergent or elective. In the placement of these devices particular attention and effort must be made to understand safe and reliable anatomic techniques and device maintenance so as to avoid serious injury to the patient. This review focuses on complications of chest tube placement, with the emphasis on patient safety and error prevention.

RECENT FINDINGS

There is a paucity of high-quality recent literature on tube thoracostomy complications. With the advent of value-driven healthcare, increasing emphasis is being placed on appropriate procedural indications, procedural safety, and patient satisfaction. Good clinical outcomes are critical to achieve and maintain in this context.

SUMMARY

Given the high volume of tube thoracostomies globally, greater awareness of potential complications and preventive strategies is needed. The authors attempt to bridge this important gap.

Thoracostomy tubes: A comprehensive review of complications and related topics

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.

A method for chest drainage after pediatric cardiac surgery: A prospective randomized trial

OBJECTIVES

The purposes of this study were to evaluate the clinical safety and efficacy of 10F, 15F, and 19F Blake drains (Ethicon, Sommerville, NJ) in a pediatric population after cardiac surgery and to compare their clinical effect with that of conventional chest drains.

METHODS

From January 2002 through December 2004, a prospective randomized trial was conducted on 189 patients who underwent surgical intervention for congenital heart disease at our institution. Statistical analyses were conducted to test the null hypothesis that there was no difference in the incidence of pericardial or pleural effusion requiring drainage. Secondary end points included total volume of drainage, drain size, and time to drain removal.

RESULTS

Ninety-eight patients (group A) received Blake drains, and 91 patients (group B) received conventional chest drains. There were no statistically significant difference in age, weight at the time of surgical intervention, open- and closed-heart procedures, and number of drains applied. Statistically significant differences were detected in the frequency of pericardial effusion (group A: 1.1% vs group B: 4.8%, P < .01), pleural effusion (group A: 1.1% vs group B: 5.3%, P < .01), size of the drain (group A: 12.37 French +/- 1.72 French vs group B: 16.81 French +/- 0.70 French, P < .001), and time to removal (group A: 43.75 +/- 20.76 hours vs group B: 55.62 +/- 26.48 hours, P < .001).

CONCLUSIONS

Blake drains are safer and more efficient than conventional chest tubes in pediatric populations after cardiac surgery. In comparison with conventional chest tubes, they showed fewer occurrences of effusions and the same amount of fluid drained but smaller size and earlier removal.

Efficacy of BlakeR Drains for Mediastinal and Pleural Drainage Following Cardiac Operations

BACKGROUND

Mediastinal and pleural drainage following cardiac operations has traditionally been achieved with large bore, semirigid chest tubes. The purpose of this study was to evaluate the safety and efficacy of drainage by means of small, soft, and flexible 19 F Blake drains.

METHODS

This is a review of all patients who underwent heart surgery over a 3-year period at a single institution. Chest tubes and Blake drains were removed on postoperative day 1 to 5 depending on patient's condition, amount of drainage, and surgeon's preference. The criteria for drain removal did not vary with type of drain.

RESULTS

There was no significant difference in the amount of drainage between both groups. Postoperative mediastinal exploration occurred in 3.47% of patients (12/346) in the chest tube group and in 2.08% of patients (8/385) in the Blake group (p = 0.27). Significant pleural effusions requiring a subsequent drainage procedure occurred in 9.54% of patients (33/346) in the chest tube group and in 9.87% of patients (38/385) in the Blake group.

CONCLUSIONS

No significant differences were noted in the number of mediastinal explorations in patients drained with conventional chest tubes as compared to Blake drains during cardiac operations. Though not statistically significant, there may actually be an advantage of Blake drains over conventional chest tubes in this regard. There was also no significant difference in the incidence of postoperative pleural effusions. Blake drains appear to be at least as effective and safe as conventional chest tubes in draining the mediastinum and pleural spaces following cardiac surgery.

Silastic drains vs conventional chest tubes after coronary artery bypass

STUDY OBJECTIVES

To investigate differences in drainage amounts and early clinical outcomes associated with the use of Silastic drains, as compared with the conventional chest tube after coronary artery bypass grafting (CABG).

DESIGN

Retrospective nonrandomized case control study.

SETTING

A tertiary teaching hospital.

PATIENTS AND PARTICIPANTS

Outcome data from 554 patients who underwent postoperative pericardial decompression using small Silastic drains were compared with those from 556 patients who had conventional chest tubes after first-time CABG at our institution between January 1 and August 1, 2000.

MEASUREMENT AND RESULTS

Univariate analysis of preoperative characteristics was used to ensure similarity between the two patient groups. Operative mortality, mediastinitis, reoperation for bleeding, and early and late cardiac tamponade occurred in 9 patients (1.6%), 6 patients (1.1%), 6 patients (1.1%), 6 patients (1.1%), and 1 patient (0.2%), respectively, in the Silastic drain group, compared with 11 patients (2.0%), 9 patients (1.6%), 4 patients (0.7%), 2 patients (0.4%), and 6 patients (1.1%) in the conventional group. No statistically significant differences between the two drains were identified. Drainage amounts (mean +/- SD) were 552.2 +/- 281.8 mL and 548.8 mL +/- 328.7 mL for the Silastic and conventional groups, respectively (p = 0.51). Postoperative length of stay was longer for the conventional chest tube group (median, 5 d; range, 1 to 119 d) when compared to the Silastic drain group (median, 4 d; range, 1 to 66 d; p = 0.01).

CONCLUSIONS

We demonstrated that small Silastic drains are equally as effective as the conventional, large-bore chest tubes after CABG with no significant risk of bleeding or pericardial tamponade. Additionally, use of Silastic drains allows more mobility than the conventional chest tubes. As a result of this study, there was a change in our clinical practice toward the exclusive use of Silastic drains after all cardiac surgical procedures.

A method for mediastinal drainage after cardiac procedures using small silastic drains

BACKGROUND

It has been standard teaching in cardiac surgery that drainage of the mediastinum following cardiac surgical procedures is best accomplished using rigid large-bore chest tubes. Recent trends in cardiac surgery have suggested less invasive approaches to a variety of diseases. Difficult drainage problems in the field of general surgery including hepatic and pancreatic collections have been drained successfully with smaller flexible drains for many years. Additionally, many difficult to reach collections in the chest have been drained by invasive radiologists using small pigtail catheters.

METHODS

We have introduced drainage of the mediastinum using 10-mm flexible, flat, fluted Blake drains. To date, we have used these drains in more than 100 cardiac operations including coronary artery bypass grafting, valve repair/replacements, combined coronary artery bypass grafting/valve operations, heart transplants, septal defects, and mediastinal tumors.

RESULTS

We have demonstrated that this form of drainage is as good as using large-bore chest tubes with no significant risk of bleeding or tamponade. Additionally, use of these tubes is less painful, allows more mobility, and earlier discharge with functioning drains in place if necessary.

CONCLUSIONS

Larger chest tubes are not necessarily better when it comes to draining the mediastinum. The actual area of ingress through the sideholes is considerably less than the surface area provided by the fluted Blake drain. We believe that this system can replace standard chest tubes.