Survey of major complications of intercostal chest drain insertion in the UK

Abstract

Background Following reports from the National Patient Safety Agency of deaths and serious harm from intercostal chest drains (ICD) we conducted a national survey among chest physicians of their experience of harm associated with ICD. Methods A questionnaire was sent to 198 UK chest physicians at 148 acute hospital trusts, enquiring about current practice and any adverse incidents related to chest drains from 2003 to 2008. Results 101 of 148 trusts (68%) replied. 67 trusts reported at least one major incident involving ICD insertion. 31 Cases of ICD misplacement were reported with seven deaths. Misplaced drains were inserted in liver (10), peritoneal space (6), heart (5), spleen (5), subclavian vessels (2), colon (1), oesophagus (1) and inferior vena cava (1). 47 cases of serious lung or chest wall injuries with eight deaths and six cases of ICD placement on the wrong side with two deaths were reported. The guidewire was lost in the pleural cavity in three cases. 22 of 101 trusts required written patient consent before ICD insertion. 11 trusts had a training policy. 16 trusts had patient information literature for this procedure. The seniority of doctors permitted to insert ICDs was as follows: 30% any doctor; 27% at least 1 year post qualification; 32% at least 2 years, 11% at least 4 years. Conclusions 67% of responding trusts had encountered major complications of ICD. The survey raised concerns about training and consent. The National Patient Safety Agency has made recommendations to address these risks which are also addressed in the 2009 update of the British Thoracic Society Pleural Disease Guideline.