Abstract
A patient with post-pneumonia empyema complicated by type-2 respiratory failure required mechanical ventilation as part of his therapy. A pneumothorax was noted on his chest radiograph. This was treated with an intercostal chest drain (ICD). Unfortunately, he was still hypoxic, his subcutaneous emphysema was worsening and the ICD was bubbling. A computed tomography (CT) scan of chest demonstrated that the ICD has penetrated the right upper lobe parenchyma. A new ICD was inserted and the previous one was removed. Although both hypoxia and subcutaneous emphysema improved, the patient chronically remained on mechanical ventilation.
Highlights
Tube thoracostomy is a common procedure to drain fluids and/or air from the pleural space via an intercostal chest drain (ICD)
Under aseptic technique and blunt dissection a large bore ICD was inserted anterolaterally into the right chest preceded by the introduction of index finger and sweeping manoeuvre explained by the British Thoracic Society (BTS) guidelines [1]
A computed tomography (CT) scan of chest demonstrated that the ICD has penetrated the right upper lobe parenchyma (Figure 1)
Summary
Tube thoracostomy is a common procedure to drain fluids and/or air from the pleural space via an ICD. The British Thoracic Society (BTS) has published a guideline [1] for ICD insertion which in many institutions has been deployed as a standard approach to tube thoracostomy in both practice and training programs. Harris et al [4] conducted a national survey among chest physicians in the UK recording their experiences regarding complications and serious harms following ICD insertion.
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