Author(s): Alrahbi R, Easton R, Bendinelli C, Enninghorst N, Sisak K,
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Abstract INTRODUCTION: Intercostal catheters (ICC) are the standard management of chest trauma, but are associated with complications in up to 30\%. The aim of this study was to evaluate errors in technique during ICC insertion to characterize the potential benefit of improved training programmes. METHODS: Prospective audit of all ICC in trauma patients at a level 1 trauma centre for over 12 months. Exclusions were pigtail catheters and ICC inserted during thoracic surgery. Errors were identified from patient examination and chest imaging; they were defined as insertional, positional, incorrect size (<28 French) and lack of antibiotic prophylaxis. Ongoing complications unrelated to an error in technique, for example blocked tube, were not analysed. RESULTS: Fifty-seven patients received a total of 94 ICC during the study period. Patients were predominantly male (77\%), mean age of 40 ± 20 years, mean injury severity score 27 ± 13, mean abbreviated injury scale chest 3.8 ± 0.72. 86\% were blunt trauma and 14\% penetrating chest injuries. Thirty-six errors in technique occurred in 33 ICC insertions (38\%). The most common errors were absence of prophylactic antibiotics (13\%), ICC too far out (9\%), kinked (6\%) and wrong-sized ICC (5\%). Emergency had a significantly greater frequency of errors than other specialties (67\%, relative risk 2.11, P= 0.002). The majority of ICC were inserted by registrars, and registrars made a greater number of errors than fellows or consultants (relative risk 2.00, P= 0.02). DISCUSSION: This study identified a large number of preventable errors for ICC insertion in trauma patients. Standardized institutional credentialing systems may be required to ensure adequate proficiency of trainees performing this procedure. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.
This article was published in ANZ J Surg
and referenced in Journal of Pulmonary & Respiratory Medicine