QUALITY IMPROVEMENT INITIATIVE TO REDUCE THE RATES OF CHEST TUBE FAILURE IN MANAGEMENT OF IATROGENIC PNEUMOTHORAX FOLLOWING CT-GUIDED LUNG BIOPSY

Abstract

TOPIC: Procedures TYPE: Original Investigations PURPOSE: Iatrogenic pneumothorax following Interventional Radiology (IR) CT-guided transthoracic lung biopsy is a frequent complication with reported rates between 12-45% of which 2-15% will require thoracostomy tube placement. Recently, smaller tube sizes have been made commercially available, but it is unclear if these tubes are as efficacious and safe as larger chest tubes in the management of iatrogenic pneumothorax following lung biopsy. A previous quality assessment project at our institution demonstrated higher failure rates in chest tubes of less than 10 French (Fr). Our objective was to reduce the incidence of chest tube failure when managing iatrogenic pneumothorax after CT-guided lung biopsy via IR. METHODS: After demonstrating a failure rate in smaller bore chest tubes, we met with our interventional radiology colleagues and decided to place 10 Fr chest tubes or larger after iatrogenic pneumothorax following CT-guided lung nodule biopsies. As with our previous quality assessment project, we then retrospectively completed a chart review from January 2018 to March 2021 on all IR CT-guided lung nodules biopsied and identified cases of iatrogenic pneumothorax requiring chest tube placement and those with chest tube failure. We again defined chest tube failure as expanding pneumothorax requiring additional chest tube insertion or tension pneumothorax. RESULTS: In the pre-intervention group, there were a total of 7 chest tubes of less than 10 Fr and 5 chest tube failures in the 78 cases that required chest tube insertion (9% & 6% respectively). In the post-intervention group, no catheters smaller than 10 Fr were placed and there were no chest tube failures in the 54 cases that required chest tube insertion (0%); 6 (11%) individuals had a 10 Fr, 7 (13%) had a 12 Fr, and the remaining 41 (76%) had a 14 Fr chest tube inserted. The absence of chest tubes smaller than 10 Fr in the post-intervention group was statistically significant (p=0.02). There were no failures in the post-intervention group compared to 6% in the pre-intervention group (p=0.06). CONCLUSIONS: This analysis suggests a reduction in complication rates with the use of chest tubes 10 Fr or larger in management of iatrogenic pneumothorax from CT guided lung biopsy. This quality improvement project has demonstrated a significant change in practice habits with a trend toward reduced failure rates. A larger analysis will be needed to examine the statistical significance of reduced complications after intervention. CLINICAL IMPLICATIONS: This study demonstrated a change in practice habits toward larger sized chest tubes in the management of iatrogenic pneumothorax from CT-guided lung nodule biopsy. A larger analysis will be needed to demonstrate optimal chest tube size. DISCLOSURES: No relevant relationships by hassan Al-Balas, source=Web Response No relevant relationships by Stephen Bujarski, source=Web Response No relevant relationships by Sunjay Devarajan, source=Web Response No relevant relationships by James Ramey, source=Web Response No relevant relationships by Sarah Tuthill, source=Web Response