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Bruno Jose. Challenging chest drainage: a case report. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction. Chest trauma is one of the most common causes of death corresponding to 20 to 25 % of cases. The majority of the patients (85%), can be managed with only a tube thoracostomy. Our objective by presenting this case report is to provide an example of how to manage a challenging chest tube thoracostomy in a patient with cardiac hernia diagnosed in the preoperative phase, based on signs of computed tomography.
Case report. A 45-year-old male presented to our emergency department who fell from a light pole 7 meters high. He fell to the ground on his back. Physical examination revealed a huge subcutaneous emphysema on his entire anterior chest wall and presented no sensitivity or movements below the navel line. After the initial assessment and management care, the patient improved. As the patient stabilized we decided to go to CT. The scan revealed pericardial rupture with only the right pericardial circumference intact, the heart herniated into the left pleural space, bilateral pneumothorax, small right hemothorax and a relevant subcutaneous emphysema surrounding the chest. We decided to perform the blunt dissection technique to insert chest tubes bilaterally because of safety. After performed it the patient was transferred to cardiothoracic department.
Discussion. There is a variety of techniques to perform tube thoracostomy but the blunt dissection remain the safer, especially when we are facing an anatomic distortion of the heart.
Conclusion. We present a case report of a challenging thoracic drainage performed in a patient with traumatic cardiac hernia, which procedure was successful.
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McGill M, Aggarwal V, Hiremath G. Device Closure of Iatrogenic Left Ventricular Perforation Through the Chest Wall. JACC Cardiovasc Interv 2020; 13:897-898. [PMID: 31883718 DOI: 10.1016/j.jcin.2019.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 09/30/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Mark McGill
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - Varun Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - Gurumurthy Hiremath
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota.
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Yeoh CB, Fischer GW, Tollinche LE. Focused Transesophageal Echocardiography for Bedside Diagnosis of Iatrogenic Cardiac Perforation: A Case Report. A A Pract 2020; 13:407-408. [PMID: 31425159 DOI: 10.1213/xaa.0000000000001077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe an extremely rare complication of chest tube placement and focused transesophageal echocardiography (TEE) in the diagnosis of a life-threatening condition. It illustrates the value and utility of point-of-care ultrasound (POCUS) by way of a focused TEE in confirming a diagnosis and contributing toward the expeditious operative management of a life-threatening scenario. POCUS continues to gain traction in the field of anesthesiology. However, incorporation of POCUS training into curriculum of anesthesia residency programs is still in the infancy stages. Our report demonstrates the need for development and standardization of POCUS training for anesthesiologists in the perioperative setting.
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Affiliation(s)
- Cindy B Yeoh
- From the Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Varghese S, Slottosch I, Saha S, Wacker M, Awad G, Wippermann J, Scherner M. Surgical Management of Iatrogenic Left Ventricle Perforation by Chest Tube Insertion. Ann Thorac Surg 2019; 108:e405-e407. [PMID: 31470008 DOI: 10.1016/j.athoracsur.2019.06.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/24/2019] [Accepted: 06/30/2019] [Indexed: 10/26/2022]
Abstract
Chest tube thoracostomy is a standard procedure in every intensive care unit. Although it is regarded as a safe procedure in experienced hands, rare complications do occur. This report describes iatrogenic perforation of the left ventricle after placement of an intercostal catheter and the successful surgical management of this injury. Various operative situations that may arise in relation to iatrogenic perforation of the left ventricle are also discussed, as well as steps to manage this potentially life-threatening complication.
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Affiliation(s)
- Sam Varghese
- Department of Cardiothoracic Surgery, University Hospital, Otto-von-Guericke-University, Magdeburg, Germany.
| | - Ingo Slottosch
- Department of Cardiothoracic Surgery, University Hospital, Otto-von-Guericke-University, Magdeburg, Germany
| | - Shekhar Saha
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Georg-August-University, Göttingen, Germany
| | - Max Wacker
- Department of Cardiothoracic Surgery, University Hospital, Otto-von-Guericke-University, Magdeburg, Germany
| | - George Awad
- Department of Cardiothoracic Surgery, University Hospital, Otto-von-Guericke-University, Magdeburg, Germany
| | - Jens Wippermann
- Department of Cardiothoracic Surgery, University Hospital, Otto-von-Guericke-University, Magdeburg, Germany
| | - Maximilian Scherner
- Department of Cardiothoracic Surgery, University Hospital, Otto-von-Guericke-University, Magdeburg, Germany
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Gimpel D, Magoye T, McCormack DJ, El-Gamel A, Kejriwal N. Inadvertent puncture of right ventricle during chest tube insertion. ANZ J Surg 2019; 90:376-378. [PMID: 30983139 DOI: 10.1111/ans.15132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/04/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Damian Gimpel
- Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand.,Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Theresa Magoye
- Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand
| | - David J McCormack
- Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand.,Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Adam El-Gamel
- Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand.,National Institute of Demographic and Economic Analysis, The University of Waikato, Waikato, New Zealand
| | - Nand Kejriwal
- Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand.,Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Farinas Lugo D, Chalasani P, Del Calvo V. Left ventricular puncture during thoracentesis. BMJ Case Rep 2019; 12:12/4/e227613. [PMID: 30967447 DOI: 10.1136/bcr-2018-227613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Left ventricular puncture during a thoracentesis is a rare and unusual complication that has yet to be reported. We report a case in which a 74-year-old woman with dilated ischaemic heart disease suffered from puncture of the left ventricle during a routine ultrasound-guided thoracentesis despite following the recommended protocol and procedures. She became haemodynamically unstable and underwent an emergent thoracotomy for removal of the catheter and repair of the left ventricular wall.
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Affiliation(s)
- Daniel Farinas Lugo
- Department of Cardiology, College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Prasad Chalasani
- Department of Cardiology, College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Veronica Del Calvo
- Department of Cardiology, College of Medicine, Florida State University, Tallahassee, Florida, USA
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Deshpande SP, Chow JH, Odonkor P, Griffith B, Carr SR. Misadventures of a Pigtail: Case Report of Accidental Insertion of a Chest Tube Into the Left Atrium During Interventional Radiology-Guided Placement. A A Pract 2018; 11:273-275. [PMID: 29894345 DOI: 10.1213/xaa.0000000000000807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Seema P Deshpande
- From the Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
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Unusual Malposition of a Chest Tube, Intrathoracic but Extrapleural. Case Rep Radiol 2018; 2018:8129341. [PMID: 30174979 PMCID: PMC6106908 DOI: 10.1155/2018/8129341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 06/25/2018] [Accepted: 07/12/2018] [Indexed: 11/17/2022] Open
Abstract
Chest tube malpositioning is reported to be the most common complication associated with tube thoracostomy. Intraparenchymal and intrafissural malpositions are the most commonly reported tube sites. We present a case about a 21-year-old patient with cystic fibrosis who was admitted due to bronchiectasis exacerbation and developed a right-sided pneumothorax for which a chest tube was inserted. Partial initial improvement in the pneumothorax was noted on the chest radiograph, after which the chest tube stopped functioning and the pneumothorax remained for 19 days. Chest computed tomography was done and revealed a malpositioned chest tube in the right side located inside the thoracic cavity but outside the pleural cavity (intrathoracic, extrapleural). The removed chest tube was patent with no obstructing materials in its lumen. A new thoracostomy tube was inserted and complete resolution of the pneumothorax followed.
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Bradycardia after Tube Thoracostomy for Spontaneous Pneumothorax. Case Rep Emerg Med 2018; 2018:6351521. [PMID: 29755798 PMCID: PMC5884237 DOI: 10.1155/2018/6351521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 02/15/2018] [Indexed: 11/18/2022] Open
Abstract
We present the case of an elderly patient who became bradycardic after chest tube insertion for spontaneous pneumothorax. Arrhythmia is a rare complication of tube thoracostomy. Unlike other reported cases of chest tube induced arrhythmias, the bradycardia in our patient responded to resuscitative measures without removal or repositioning of the tube. Our patient, who had COPD, presented with shortness of breath due to spontaneous pneumothorax. Moments after tube insertion, patient developed severe bradycardia that responded to Atropine. In patients requiring chest tube insertion, it is important to be prepared to provide cardiopulmonary resuscitative therapy in case the patient develops a life-threatening arrhythmia.
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Ruparel RK, Laack TA, Brahmbhatt RD, Rowse PG, Aho JM, AlJamal YN, Kim BD, Morris DS, Farley DR, Campbell RL. Securing a Chest Tube Properly: A Simple Framework for Teaching Emergency Medicine Residents and Assessing Their Technical Abilities. J Emerg Med 2017; 53:110-115. [PMID: 28408233 DOI: 10.1016/j.jemermed.2017.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 02/22/2017] [Accepted: 02/25/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Quality-improvement efforts at our institution have identified chest tube dislodgement as a preventable complication of tube thoracostomy. Because proper fixation techniques are not well described in the literature and are seldom formally taught, techniques vary among residents. OBJECTIVE Our aim was to develop and test a framework for teaching and assessing chest tube securement. METHODS A repeated-measures study design was used. At baseline, 19 emergency medicine residents (program years 1-3) placed and secured a chest tube in a cadaver. After a 45-min proficiency-based teaching session using a low-cost chest tube simulator (approximate cost, $5), each resident again placed and secured a chest tube in a cadaver, followed by 3-month retention testing. All securements were evaluated by two raters using a four-point checklist and a five-point global assessment scale (GAS). The checklist addressed suture selection, tying knots down to the tube, wound approximation, and tube displacement relative to skin. RESULTS After the initial educational intervention, median scores for the group improved significantly over baseline for the GAS (p < 0.001), checklist (p < 0.001), and amount of displacement (p = 0.01). At 3 months, GAS, checklist, and displacement scores did not differ significantly from the immediate post-test scores. Inter-rater reliability was substantial, with weighted κ values of .77 for the GAS and .70 for the checklist. CONCLUSIONS Quality of chest tube securement by emergency medicine residents can be significantly improved with an inexpensive chest tube simulator and a brief workshop. The four-point checklist served as a reliable and effective means for teaching and assessing chest tube securement.
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Affiliation(s)
- Raaj K Ruparel
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Torrey A Laack
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | - Brian D Kim
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - David S Morris
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - David R Farley
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Ronna L Campbell
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
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Anitha N, Kamath SG, Khymdeit E, Prabhu M. Intercostal drainage tube or intracardiac drainage tube? Ann Card Anaesth 2017; 19:545-8. [PMID: 27397467 PMCID: PMC4971991 DOI: 10.4103/0971-9784.185561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Although insertion of chest drain tubes is a common medical practice, there are risks associated with this procedure, especially when inexperienced physicians perform it. Wrong insertion of the tube has been known to cause morbidity and occasional mortality. We report a case where the left ventricle was accidentally punctured leading to near-exsanguination. This report is to highlight the need for experienced physicians to supervise the procedure and train the younger physician in the safe performance of the procedure.
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Affiliation(s)
- N Anitha
- Department of Anaesthesiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - S Ganesh Kamath
- Department of Cardiovascular Thoracic Surgery, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Edison Khymdeit
- Department of Anaesthesiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Manjunath Prabhu
- Department of Anaesthesiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Tube Thoracostomy: A Structured Review of Case Reports and a Standardized Format for Reporting Complications. World J Surg 2016; 39:2691-706. [PMID: 26159120 DOI: 10.1007/s00268-015-3158-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Although seemingly straightforward, tube thoracostomy (TT) has been associated with complication rates as high as 30 %. A lack of a standardized nomenclature for reporting TT complications makes comparison and evaluation of reports impossible. We aim to develop a classification method in order to standardize the reporting of complications of TT and identify all reported complications of TT and time course in which they occurred to validate the reporting method. METHODS A systematic search of MEDLINE, Scopus, EMBASE, and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews from each databases inception through November 5, 2013 was conducted. Original articles written in the English language reporting TT complications were searched. This review adhered to preferred reporting items for systematic reviews and meta-analyses (PRISMA) standards. Duplicate reviewers abstracted case reports for inclusion. Cases were then sorted into one of the five complication categories by two reviewers, and in case of disagreements, settled by a third reviewer. RESULTS Of 751 papers reporting TT complications, 124 case reports were included for analysis. From these reports, five main categories of TT complications were identified: insertional (n = 65); positional (n = 36); removal (n = 11); infective and immunologic (n = 7); and instructional, educational, or equipment related (n = 5). Placement of TT has occurred in nearly every soft tissue and vascular structure in the thoracic cavity and intra-abdominal organs. CONCLUSION Our classification method provides further clarity and systematic standardization for reporting TT complications.
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