Complication Of Tube Thoracostomy Research Articles

Tube Thoracostomy Complications inPatients With ARDS Requiring ECMO: Worse inCOVID-19 Patients?

The incidence and management outcomes of COVID-19 patients with acute respiratory distress syndrome (ARDS) on veno-venous extracorporeal membrane oxygenation (V-V ECMO) requiring chest tubes are not well-described. This study sought to explore differences in tube thoracostomy rates and subsequent complications between patients with and without COVID-19 ARDS on V-V ECMO. This study is a single institution, retrospective cohort study of patients with COVID-19 ARDS requiring V-V ECMO. The control cohort consisted of patients who required V-V ECMO for ARDS-related diagnoses from January 2018 to January 2021. The primary outcome was any complication following initial tube thoracostomy placement. Study approval was obtained from the Brooke Army Medical Center Institutional Review Board (C.2017.152d). Twenty-five COVID-19 patients and 38 controls were included. Demographic parameters did not differ between the groups. The incidence of pneumothorax was not significantly different between the two groups (44% COVID-19 vs. 22% control, OR 2.8, 95% CI 0.95-7.9, P = 0.09). Patients with COVID-19 were as likely to receive tube thoracostomy as controls (36% vs. 24%, OR 1.8, 95% CI 0.55-5.7). Complications, however, were more likely to occur in the COVID-19 group (89% vs. 33%, OR 16, 95% CI, 1.6-201, P = 0.0498). Tube thoracostomy placement in COVID-19 patients with ARDS requiring V-V ECMO is common, as are complications following initial placement. Clinicians should anticipate the need for re-intervention in this patient population. Small-bore (14Fr and smaller) pigtail catheters appeared to be safe and efficacious in this setting, but further study on tube thoracostomy management in ECMO patients is needed.

Tube Thoracostomy Complications in Patients with ARDS Requiring Extracorporeal Membrane Oxygenation: Worse in COVID-19 Patients?

Tube Thoracostomy Complications in Patients with ARDS Requiring Extracorporeal Membrane Oxygenation: Worse in COVID-19 Patients?

Observational management of penetrating occult pneumothoraces: Outcomes and risk factors for interval tube thoracostomy placement.

Guidelines for penetrating occult pneumothoraces (OPTXs) are based on blunt injury. Further understanding of penetrating OPTX pathophysiology is needed. In observational management of penetrating OPTX, we hypothesized that specific clinical and radiographic features may be associated with interval tube thoracostomy (TT) placement. Our aims were to (1) describe OPTX occurrence in penetrating chest injury, (2) determine the rate of interval TT placement in observational management and clinical outcomes compared with immediate TT placement, and (3) describe risk factors associated with failure of observational management. Penetrating OPTX patients presenting to our level 1 trauma center from 2004 to 2019 were reviewed. Occult pneumothorax was defined as a pneumothorax on chest computed tomography but not on chest radiograph. Patient groups included immediate TT placement versus observation. Clinical outcomes compared were TT duration and complications, need for additional thoracic procedures, length of stay (LOS), and disposition. Clinical and radiographic factors associated with interval TT placement were determined by multivariable regression. Of 629 penetrating pneumothorax patients, 103 (16%) presented with OPTX. Thirty-eight patients underwent immediate TT placement, and 65 were observed. Twelve observed patients (18%) needed interval TT placement. Regardless of initial management strategy, TT placement was associated with longer LOS and more chest radiographs. Chest injury complications and outcomes were similar. Factors associated with increased odds of interval TT placement included Chest Abbreviated Injury Scale score of ≥4 (adjusted odds ratio [aOR], 7.38 [95% confidence interval, 1.43-37.95), positive pressure ventilation (aOR, 7.74 [1.07-56.06]), concurrent hemothorax (aOR, 6.17 [1.08-35.24]), and retained bullet fragment (aOR, 11.62 [1.40-96.62]) (all p < 0.05). The majority of patients with penetrating OPTX can be successfully observed with improved clinical outcomes (LOS, avoidance of TT complications, reduced radiation). Interval TT intervention was not associated with risk for adverse outcomes. In patients undergoing observation, specific clinical factors (chest injury severity, ventilation) and imaging features (hemothorax, retained bullet) are associated with increased odds for interval TT placement, suggesting need for heightened awareness in these patients. Prognostic, level IV.

Beyond the tube: Can we reduce chest tube complications in trauma patients?

BackgroundWe sought to identify opportunities for interventions to mitigate complications of tube thoracostomy (TT). MethodsRetrospective review of all trauma patients undergoing TT from 6/30/2016–6/30/2019. Multivariable logistic regression identified independent predictors of complications. ResultsOut of 451 patients, 171 (37.9%) had at least one TT malpositioning or complication. Placement in the emergency department, placement by emergency medicine physicians, and body mass index >30 kg/m2 were independent predictors of complication. Malpositioning increased the likelihood of early complication (6.5%–53.5%), and early complication increased the likelihood of late complication (4.3%–13.6%). Patients with a late complication had, on average, a 7.56 day longer hospital stay than patients without a late complication. ConclusionTT complications were associated with placement in the emergency department, placement by emergency medicine physicians, and BMI>30 kg/m2. We identified associations between malpositioning, early complications, and late complications, and demonstrated that TT complications impact patient outcomes.

Complications related to tube thoracostomy in Southwest Finland hospital district between 2004 and 2014.

The purpose of this study was to describe the frequency and types of complications after tube thoracostomy among all patients treated with tube thoracostomy for both traumatic and non-traumatic indications. Retrospective register-based study of patients treated with tube thoracostomy between the years 2004 and 2014 in a university hospital. In total, 1808 patients who had undergone tube thoracostomy were identified, complete data on tube thoracostomy treatment was available for 1169 patients. A total of 233 (19.9%) patients had 289 complications, 284 (98.3%) were positional resulting in tube malfunction. In 84 (7.2%) patients, malposition of the tube resulted in need for non-urgent operative treatment. There were 103 in-hospital deaths, but none due to tube thoracostomy complications. Empyema as a treatment indication was more frequent in patients with complications (15.9% vs 6.8%, p < 0.001) as was diabetes (21.9% vs 13.2%, p = 0.001). The likelihood of complications was lower with CH16 tubes (odds ratio 0.22, p < 0.001) and higher in diabetics (odds ratio 1.86, p = 0.001). Tube thoracostomy is a common procedure and complications occur in 19.9% of patients. Serious complications caused by the chest tube placement, however, are extremely rare. Complications were most common in patients treated for empyema and diabetics. Small CH16 tubes were associated with a lower incidence of complications.

Culture results on chest tube thoracostomy water-sealed drainage in patients with pneumothorax at Sanglah General Hospital, Bali-Indonesia

Introduction: Thoracic trauma is one type of trauma with a high incidence that causes morbidity and mortality after head trauma and extremity. The act of installing a thoracostomy has become one of the standard management of thoracic injury. Infection is a complication that can occur during treatment. This study aimed to provide an overview of the results of thoracostomy tube water-sealed drainage (WSD) culture in pneumothorax patients at Sanglah Hospital.Method: The study design used a cross sectional descriptive method. The subjects of the study were blunt thoracic trauma patients with pneumothorax who came to the emergency department of Sanglah Hospital to indicate the installation of a thoracostomy hose during the period January to December 2018.Results: From 40 study samples there were 32 subjects with positive culture results, then from all subjects with positive culture results found 10 people (25%) with culture results of staphylococcal aureus bacteria, based on rib fractures more samples with rib fractures less than two bones ( 62.5%), based on the duration of WSD installation there were more samples with the duration of WSD installation more than 7 days (75%).Conclusion: The high positive culture results which are dominated by pyogenic skin bacteria, namely Stapylokokus aureus is a challenge for surgeons in managing the complications of tube thoracostomy (TT) installation in patients with pneumothorax.

External Validation of a Tube Thoracostomy Complication Classification System.

Tube thoracostomy (TT) is a commonly performed procedure which is associated with significant complication rates. Currently, there is no validated taxonomy to classify and compare TT complications across different populations. This study aims to validate such TT complication taxonomy in a cohort of South African trauma patients. Post hoc analysis of a prospectively collected trauma database from Pietermaritzburg Metropolitan Trauma Service (PMTS) in South Africa was performed for the period January 2010 to December 2013. Baseline demographics, mechanism of injury and complications were collected and categorized according to published classification protocols. All patients requiring bedside TT were included in the study. Patients who necessitated operatively placed or image-guided TT insertion were excluded. Summary and univariate analyses were performed. A total of 1010 patients underwent TT. The mean age was (±SD) of 26±8years. Unilateral TTs were inserted in n=966 (96%) and bilateral in n=44 (4%). Complications developed in 162 (16%) patients. Penetrating injury was associated with lower complication rate (11%) than blunt injury (26%), p=0.0001. Higher complication rate was seen in TT placed by interns (17%) compared to TT placed by residents (7%), p=0.0001. Complications were classified as: insertional (38%), positional (44%), removal (9%), infective/immunologic (9%), and instructional, educational or equipment related (0%). Despite being developed in the USA, this classification system is robust and was able to comprehensively assign and categorize all the complications of TT in this South African trauma cohort. A universal standardized definition and classification system permits equitable comparisons of complication rates. The use of this classification taxonomy may help develop strategies to improve TT placement techniques and reduce the complications associated with the procedure. V. Single Institution Retrospective review.

Securing a Chest Tube Properly: A Simple Framework for Teaching Emergency Medicine Residents and Assessing Their Technical Abilities

BackgroundQuality-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. ObjectiveOur aim was to develop and test a framework for teaching and assessing chest tube securement. MethodsA 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. ResultsAfter 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. ConclusionsQuality 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.

Hepatic Hydrothorax: The Conundrum and the Oxymoron

AbstractHepatic hydrothorax (HH) is an infrequent but a well-known complication of portal hypertension. Medical management of this condition often fails, and there are no large randomized-controlled trials establishing the best treatment strategies. HH thus represents a formidable entity in the management of end-stage liver disease, and the only definitive treatment is liver transplantation. Despite documented ominous outcome, tube thoracostomy (TT) is still a widely practiced approach to HH mostly by the unaware primary care physician. This communication reports the occurrence of pleurosubcutaneous fistula as a presenting complication of TT in a patient with HH. TT should thus be avoided at all costs in this subset of patients because it is fraught with multiple complications. This report reinforces the importance of clinical education and awareness of these complications and outcomes of TT in a cirrhotic patient with HH.

Tube Thoracostomy Complications Increase Cost.

Tube thoracostomy (TT) can be an effective therapy for thoracic pathologies. Ineffective placement of TT is common and associated with significant complications. Complications require additional interventions to repair damaged tissues or replace dysfunctional TT. We hypothesize that complicated TT insertion increases cost to the hospital system. Adult trauma patients requiring TT at a level 1 trauma center (2012-2013) were reviewed. Intraoperative or image-guided TT placements were excluded. Baseline demographics and TT insertion cost (normalized and assigned by hospital billing records) were recorded. Costs included initial TT equipment, radiographs, and subsequent operative or radiologic intervention to correct TT complications. Complications were categorized using previously validated method. Secondary outcomes included: number of TT inserted, number of chest radiographs performed, and TT dwell time utilizing a standardized TT discontinuation protocol. A total of 154 patients with 246 TT were included. Ninety TT (37%) had complication. Complication categories are postremoval (n=15, 16.7%), insertional (n=13, 14.4%), positional (n=62, 68.9%). Overall median complicated TT cost was 9 times greater than uncomplicated TT insertion, p=0.001. Insertional complications median cost 21 times greater than an uncomplicated, due to operative and radiologic interventions (p=0.0001). Positional and postremoval complication rates increased median cost by 3 times compared to uncomplicated TT (p=0.03). Operative or radiologic interventions (n=10) were performed for organ injury or uncontrolled hemo-/pneumothorax. Increased dwell time median [IQR] was associated with complicated TT compared to uncomplicated 3 [1-5] versus 2 [1-3], p=0.01. TT is a common procedure. TT complications are often considered benign. However, patients with a complicated TT insertion, especially related to insertional subtypes, have markedly increased hospitalization costs due to need for operative or radiologic repair. Level V-retrospective study. This is a retrospective single-institution study.

Comparing the Quality and Complications of Tube Thoracostomy by Emergency Medicine and Surgery Residents; a Cohort Study.

Tube thoracostomy complications depend on the operator's skill, patients' general condition and the place in which the procedure is done. The present study aimed to compare the quality and complications of tube thoracostomy carried out by emergency medicine residents (EMRs) and surgery residents (SRs). This cohort study was conducted on 18-60 years old trauma patients in need of tube thoracostomy presenting to two academic emergency departments. Quality of tube placement and its subsequent complications until tube removal were compared between SRs and EMRs using SPSS 20. 72 patients with the mean age of 37.1 ± 14.1 years were studied (86.1% male). 23 (63.8%) cases were complicated in SRs and 22 (61.1%) cases in EMRs group (total= 62.5%). Chest drain dislodgement (22.2% in SRs vs. 22.2% EMRs; p>0.99), drainage failure (19.4% in SRs vs. 16.7% EMRs; p=0.50), and surgical site infection (11.1% in SRs vs. 19.4% EMRs; p=0.25) were among the most common observed complications. The overall odds ratio of complication development was 0.89 (95% CI: 0.35-2.25, p = 0.814) for SRs and 1.12 (95% CI: 0.28-4.53, p = 0.867) for EMRs. The findings of the present study showed no significant difference between SRs and EMRs regarding quality of tube thoracostomy placement and its subsequent complications for trauma patients. The rate of complications were interestingly high (>60%) for both groups.

Tube thoracostomy: Increased angle of insertion is associated with complications.

Tube thoracostomy (TT), considered a routine procedure, has significant complications. Current recommendations for placement rely on surface anatomy. There is no information to guide operators regarding angle of insertion relative to chest wall. We aim to determine if angle of insertion is associated with complications of TT. We performed a retrospective review of adult trauma patients who necessitated TT at a Level I trauma center over a 2-year period (January 2012 to December 2013). Tube thoracostomies performed intraoperatively or using radiological guidance were excluded. Thoracic anteroposterior or posteroanterior radiographs were reviewed to determine the angle of insertion of TT relative to the thoracic wall. A previously validated classification method was used to categorize complications. Descriptive and univariate statistics were used to compare angle of insertion and complicated versus uncomplicated TT. Review identified 154 patients who underwent a total of 246 TT placed for emergent trauma. All patients had a postprocedural chest x-ray. We identified 90 complications (37%) over the study period. One hundred forty-four of the TTs reviewed had an angle of insertion less than 45 degrees of which there were 27 complications (19%). One hundred two of the TTs had an angle greater than 45 degrees and 63 complications (62%); p < 0.0001. Tube thoracostomy insertion is inherently dangerous. Placement of TT using a higher angle of insertion greater than 45 degrees is associated with increased complications. Further prospective studies quantifying TT angle of insertion on outcomes are needed. Therapeutic study, level IV.

Emergency department diagnosis of a concealed pleurocutaneous fistula in a 78-year-old man using point-of-care ultrasound.

Although the differential diagnosis for chest wall masses is broad, the vast majority are abscesses, lipomas, or sebaceous cysts. Post-operative chest wall masses can also include infection, hematoma, seroma, cancer recurrence, metastasis, and lung hernia. Bedside ultrasound has been well documented to be beneficial in the differentiation of superficial pathology.[1,2] Pleurocutaneous fistula is a pathologic communication between the pleural space and subcutaneous tissues of the chest wall. Pleurocutaneous fistula is a rare complication of tube thoracostomy, video-assisted thoracic surgery (VATS) procedures, and various pulmonary infections. There are multiple case reports of pleurocutaneous fistulas occurring after tube thoracostomy as well as secondary to pulmonary infections including tuberculosis.[3–7] VATS is becoming an increasingly common surgery for treatment of lung carcinoma, spontaneous pneumothorax, and various indications in the trauma setting. Several cases series documenting VATS complications describe pleurocutaneous fistulas after VATS procedures.[8,9] Point of care ultrasound (POCUS) is increasing in use as a diagnostic tool in the emergency department.[1,2,10–13] Here we present a case that highlights the intersection of a rare complication of a common procedure and the value of ultrasound in the diagnosis of undifferentiated masses and dyspnea in the emergency department.

Tube Thoracostomy: A Structured Review of Case Reports and a Standardized Format for Reporting Complications.

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. 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. 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. Our classification method provides further clarity and systematic standardization for reporting TT complications.

Complications of chest tubes: a focused clinical synopsis.

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. 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. 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.

Bronchocutaneous Fistula as a Rare Complication of Tube Thoracostomy

Bronchocutaneous Fistula as a Rare Complication of Tube Thoracostomy

TUBE THORACOSTOMY COMPLICATIONS IN PATIENTS WITH ACUTE BLUNT THORACIC TRAUMA DUE TO ROAD TRAFFIC ACCIDENTS – "A COMPARATIVE STUDY"

Abstract: Objective : To determine the differences in the frequency and types of Tube thoracostomy complications (TTCs) between two groups of patients (A and B) with blunt thoracic trauma (BTT), as a result of road traffic accidents (RTA). Study Design : Prospective, comparative study. Place and duration of Study : Dawadmi General Hospital (DGH), a level II trauma center, Riyadh, from December 4, 2011 to December 3, 2012. Methodology : The problem of a high number and variety of TTCs resulting due to various technical aspects of tube thoracostomy (TT) are highlighted in this study. This is a prospective comparative study enrolling a total of 140 patients with BTT due to RTA, referred to this hospital with indwelling Tube thoracostomies (TTs) (group A) or undergoing TTs at this hospital (group B) by a single thoracic surgeon within 10-15 minutes of arrival. Patients' demographic and clinical details were recorded and confirmed with the referring physicians, if necessary. The two groups were matched for age, gender, indications for TTs and the number and types of accompanying injuries. Informed consent was obtained before the procedure. Results were analyzed using SPSS v 19. Statistical significance achieved was translated into p values at 95% confidence interval. Results : Of the 119 patients, who satisfied the inclusion criteria, group A had 49 (41.2%) and group B, 70 (58.8%) patients. Males were in the majority in both groups. A total of 130 chest tubes were placed in 119 patients. Contralateral chest tubes were indicated in 3 patients in group A and 8 patients in group B (table I). The overall TTCs rate was 61.5% (80/130), with the majority in group A (88.7%; p= 0.0001). The number of technical, infective and miscellaneous TTC in group A and B were 47 (92.2%), 6 (85.7%), 18 (81.8%), and 4 (7.8%), 1(14.3%), and 4 (18.2%), respectively (table II). The majority of the chest tubes in group A were smaller than 28 Fr (p=0.0001; RR=2.98; 95% CI=2.17-4.10). Mortality due to TT in groups A and B was 2% and 0%, respectively (P=0.416;RR=2.43;CI=1.96-3.01). Patients were followed up for 56 ±23 days after discharge. Conclusion: There is a significant difference in the frequency and types of TTCs for BTT due to RTA, between groups A and B. There is an urgent need to devise targeted training modules for emergency physicians with special emphasis on recognizing TTCs and having a low threshold for rectifying these before safe transfer to a higher center. In BTT the use of small caliber (< 24 Fr) tubes with trocars should be discouraged to avoid most complications. Key words: Tube thoracostomy complications (TTCs); Blunt thoracic trauma (BTT); Road traffic accident (RTA).

Indications and complications of tube thoracostomy with improvised underwater seal bottles.

Background:Tube thoracostomy is a lifesaving and frequently performed procedure in hospitals where the expertise and necessary tools are available. Where the ideal drainage receptacle is unavailable, the underwater seal device can be improvised with bottled water plastic can especially in emergency situations.Aims and Objectives:To determine the frequencies of the various indications and complications of tube thoracostomy with improvised underwater seal.Materials and Methods:A cross-sectional study with a structured proforma was used for assessment over a 3-year period (May 2010-April 2013). The proforma was filled at the time of the procedure by the performing surgeon and patients were followed up with serial chest X-rays until certified cured. A 1.5 L bottled water container was used as the underwater seal receptacle. The data was analysed with SPSS 15 software program.Results:A total of 167 patients were managed. There were 106 (63.5%) males and 61 (36.5%) females. The mean age was 34.85 ± 16.72 with a range of 1-80 years. The most frequent indication was for malignant/paramalignant effusion, 46 (27.5%). Others were trauma, 44 (26.3%), Parapneumonic effusion, 20 (12%), postthoracotomy 14 (8.4%), empyema thoracis 12 (7.2%), heart disease and tuberculous effusion 11 (6.6%) each, pneumothorax 8 (4.8%) and misdiagnosis 1 (0.6%). A hundred and one (60.5%) of the procedures were performed by registrars, 41 (24.6%) by consultants, house officers 15 (9%) and senior registrars 10 (6%). The overall complication rate was 16.8% with the more frequent complications been empyema (5.6%) and pneumothorax (3.6%). The average duration of tube placement was 13.02 ± 12.362 days and range of 1-110 days.Conclusion:Tube thoracostomy can be a relatively safe procedure with acceptable complication rates even with improvised underwater seal drainage bottles.

Securing Chest Tubes Properly: Can Low-Fidelity, Low-Cost Simulation Improve Technical Abilities of Emergency Medicine Residents?

Quality improvement efforts at our institution have identified chest tube dislodgement as a preventable complication of tube thoracostomy. Proper fixation techniques are not well described in the literature and are seldom formally taught. As such, performance of this task among residents is variable. The aim of this study is to evaluate the effectiveness of low-fidelity simulation in improving the ability of emergency medicine (EM) residents to secure chest tubes. A repeated measures study design was employed. At baseline, residents placed and secured a chest tube in a cadaver model. Following a 45-minute proficiency-based teaching session employing a low-cost chest tube simulator (approximate cost $5), each resident again placed and secured a chest tube in a cadaver. Pre and post-intervention fixation was evaluated by two blinded raters using a content validated assessment tool consisting of a 5-point global rating scale (GRS) and a 4-point checklist. The checklist was prospectively developed by 5 attending trauma and critical care surgeons based on elements thought to be essential for adequate fixation. It addressed suture selection, degree to which knots were tied down to the tube, wound approximation and centimeters of tube displacement relative to skin. Nineteen EM residents ranging from PGY 1 to 3 were enrolled. Inter-rater reliability was substantial, with a weighted kappa of 0.78 for the GRS and 0.86 for the 4-point checklist. Mean GRS scores improved significantly from 2.1 ± 1.2 to 3.8 ± 0.8 out of 5 (p < 0.0001). Mean checklist scores improved significantly from 1.7 ± 1.3 to 3.7 ± 0.5 out of 4 (p < 0.0001). Mean displacement values improved significantly from 3.0 cm ± 2.8 to 1.2 cm ± 0.5 (p < 0.0002). Low-fidelity simulation can be used to significantly improve the ability of EM residents to secure chest tubes in cadavers. Future measures will address the impact of this education on quality measures for tube thoracostomy fixation in the clinical setting.

Horner and #8217;s syndrome: an extremely rare complication of tube thoracostomy

Chest tube insertion is the most commonly performed procedure in the thoracic surgery practice. This surgical procedure has various complications, however, Horner’s syndrome resulting from compression of the stellat ganglia due to apical insertion of chest tube is extremely rare. In this article a 21-year-old male patient who was treated with chest tube insertion for spontaneous pneumothorax at the left side is presented. The chest tube was removed after four days, however, classical triad of Horner’s syndrome including unilateral ptosis, miosis and anhydrosis developed. On the control examination performed after three months symptoms improved except for slight pitosis. It should be kept in mind that Horner’s syndrome may develop as a complication of apically placed chest tube.