Abstract
SESSION TITLE: Interventional Pulmonary SESSION TYPE: Original Investigations PRESENTED ON: 10/08/2018 04:30 PM - 05:30 PM PURPOSE: Our objective was to define the incidence of our institution's rate of small bore chest tube failure in the management of iatrogenic pneumothorax following CT-guided transthoracic lung biopsy by IR. Additionally, we looked to further assess for any difference that exists in incidence rate based on chest tube size. Ultimately, this analysis would be utilized to potentially modify current practices to improve patient safety in those veterans undergoing chest tube insertion following iatrogenic pneumothorax following IR lung biopsy. METHODS: Retrospective chart review of patients from September 2013 to December 2017 who had chest tubes placed by IR for iatrogenic pneumothorax after CT-guided transthoracic lung biopsy at this VA center. 94 cases were identified using the IR's departmental procedure log. 78 cases had sufficient documentation for analysis. Chest tube failure was defined as expanding pneumothorax requiring additional tube or upsized chest tube insertion or tension pneumothorax requiring urgent intervention. The most common reason for exclusion was lack of documentation about the size of chest tube placed. RESULTS: Four cases involved placement of a 6.5 Fr catheter, 3 cases with an 8.5 Fr catheter, 46 cases with a 10 Fr catheter, 5 cases with a 12/12.5 Fr catheter, and 20 cases with a 14 Fr catheter. The overall failure rate in small bore chest tubes was 6.4% (5/78). The failure in small bore chest tubes less than 10 Fr was 28.5% (2/7) compared to 4.2% (3/71) in small bore chest tubes greater than or equal to 10 Fr (p = 0.06 using Fisher Exact test). Tension pneumothorax requiring ICU admission for emergent chest tube upsizing occurred in 3 patients. CONCLUSIONS: In this retrospective analysis of a VA cohort undergoing CT guided lung biopsy whose course was complicated by pneumothorax requiring chest tube, there was an overall incidence of chest tube failure in 6.4%. Though there was a trend in favor of small bore tubes greater than or equal to 10 Fr, there was no statistical difference in complications between various sizes of small bore chest tubes. A larger analysis would be needed to further explore any statistically significant difference in rate of complications between these groups. CLINICAL IMPLICATIONS: In this analysis, the overall rate of small bore chest tube failure in management of iatrogenic pneumothorax following CT-guided lung biopsy was low. Currently, neither this study nor other reviewed research provides compelling data to demonstrate benefit of any one specific size of small bore chest tube versus another. Until this is demonstrated in a more appropriately powered study, management of this condition will be subject to institutional variation. DISCLOSURES: No relevant relationships by Stephen Bujarski, source=Web Response No relevant relationships by Sunjay Devarajan, source=Web Response No relevant relationships by Sarah Tuthill, source=Web Response
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