Abstract
Introduction: Following the National Patient Safety Agency alert for intercostal chest drain (ICD) insertion,our respiratory department introduced a training programme for all registrars (SpRs) & junior doctors. Emphasis was placed on completing a proforma at the time of insertion & notifying our team, so that subsequent closer monitoring of the ICD management occurred.
Methods: A retrospective study of 52 consecutive ICD insertions notified at Sandwell Hospital over a year (Jan09-Jan10, males 80%, median age 67 years) was conducted. Indications for drainage,technique,documentation & complications were audited. The results were compared with a previous departmental 6 month audit.
Results: Medical SpRs inserted 12(23.07%), respiratory SpRs & senior house officers (SHOs) 24 (46.15%), other SHOs 3 (5.7%), consultants 6 (11.5%), house officers 1 (1.9%) & in 6 (11.5%) the grade was unknown. 21 (40%) were inserted out of hours, 22 (42%) on the respiratory ward. Type of drain: 49 Seldinger (94.2%), 2 blunt dissections (3.8%), 1 pigtail (1.9%). All indications were according to British Thoracic Society guidelines: 21 pneumothoraces (40%), 29 pleural effusions (55%) & replacing 2 blocked ICDs (5%). The average length of ICD in situ 3.4 days compared to 5.2 previously. Complications included 1 empyema & 3 drains fell out. In the earlier audit, complications included ICD insertion into a bulla, 1 insertion into the liver, 2 severe site infections & 2 re-admissions for empyema.
Conclusions: ICD training programmes improve patient safety. As over half of ICDs are placed by non-respiratory junior staff, there is a continual need for training. However, this is not just about ICD insertion; post insertion care, prompted by the proforma reduces complications & length of ICD stay.
- © 2011 ERS