Pneumothorax Post Paediatric Chest Drain Removal[*]

Abstract

Objectives: Pneumothorax can be a major complication following chest drain removal. As paediatric patients have poor breath-holding compliance, the incidence in this group may be raised compared to the adult population. A small pilot study in our hospital found a pneumothorax rate post chest drain removal of 6/39 (15.4 %), which was high. The aim of this study was to determine the incidence of pneumothorax post paediatric chest drain removal after updating the guidelines for removal, and staff education. Method: A prospective audit was conducted using a structured proforma. All eligible patients admitted to Glenfield Hospital over a 6-month period were included in the study, which finally consisted of 93 patients aged 18 or under who underwent insertion of a chest drain. Results: 93 patients, with 95 episodes of placement of chest drains were included in the prospective audit. Four patients (4.2 %) had a pneumothorax post chest drain removal, with one patient requiring insertion of a further chest drain for pneumothorax, and one patient requiring an additional drain due to recurrent pleural effusion. All patients who had post procedure pneumothorax were under 1 year of age; 3 had had cardiac surgery, and 1 had an empyema. In total, 94/95 of patients had a radiograph post drain removal. 89 % of patients were admitted for cardiac surgery, 5.4 % for empyema, 3.2 % for pneumothorax, 1 patient for a left upper lobectomy, and 1 patient was on extracorporeal membranous oxygenation. Conclusions: This study found an incidence of pneumothorax post paediatric chest drain removal of 4.2 %, an improvement since the initial pilot study. A good removal technique reduces complication rates with trained staff following structured guidelines less likely to encounter problems. The application of an occlusive dressing rapidly following suture failure helps to decrease exposure times and thus lowers the incidence of pneumothorax.

Key words

cardiovascular surgery - heart valve surgery - thoracic surgery

1 Previously presented at the East Midlands Academic Showcase 2009 as a poster, where it was winner of the Audit and Management category. Presented at ASiT conference March 2010 as a poster.

References

• 1 Hunter J. Chest drain removal.  Nursing Standard. 2008;  22 (45) 35-38
• 2 Pacharn P, Heller D, Kammen B et al. Are chest radiographs routinely necessary following thoracostomy tube removal?.  Ped Radiology. 2002;  32 (2) 138-142
• 3 Van Den Boom J, Battin M. Chest radiographs after removal of chest drains in neonates: clinical benefit or common practice?.  Arch Dis Child Fetal Neonatal Ed. 2007;  92 (1) 46-48
• 4 Khan T, Chawla G, Romany D, Mallikarjuna S, Wade D. Is routine CXR following mediastinal drain removal after cardiac surgery useful?.  Eur J Cardiothorac Surg. 2008;  34 (3) 542-544
• 5 Laws D, Neville E, Duffy J. BTS guidelines for insertion of a chest drain.  Thorax. 2003;  58 (2) 53-59
• 6 Bell R, Ovadia P, Abdullah F, Spector S, Rabinovici R. Chest tube removal: end-inspiration or end-expiration?.  J Trauma. 2001;  50 (4) 674-677

1 Previously presented at the East Midlands Academic Showcase 2009 as a poster, where it was winner of the Audit and Management category. Presented at ASiT conference March 2010 as a poster.