Maritz David, Wallis Lee, Hardcastle Timothy
Division of Emergency Medicine, University of Cape Town and Stellenbosch University, Tygerberg, W Cape.
S Afr Med J. 2009 Feb;99(2):114-7.
To determine the insertional and positional complications encountered by the placement of intercostal chest drains (ICDs) for trauma and whether further training is warranted in operators inserting intercostal chest drains outside level 1 trauma unit settings.
Over a period of 3 months, all patients with or without an ICD in situ in the front room trauma bay of Tygerberg Hospital were included in the study. Patients admitted directly via the trauma resuscitation unit were excluded. No long-term infective complications were included. A self-reporting system recorded complications, and additional data were obtained by searching the department's records and monthly statistics.
A total of 3989 patients with trauma injuries were seen in the front room trauma bay during the study period; 273 (6.8%) patients with an ICD in situ or requiring an ICD were assessed in the trauma unit and admitted to the chest drain ward; 24 patients were identified with 26 complications relating to the insertion and positioning of the ICD; 22 (92%) of these had been referred with an ICD in situ. An overall complication rate of 9.5% was seen. Insertional complications numbered 7 (27%), with 19 (73%) positional complications. The most common errors were insertion at the incorrect anatomical site, and extrathoracic and too shallow placement (side portal of the drain lying outside the chest cavity).
Operators at the referral hospitals have received insufficient training in the technique for insertion of ICDs for chest trauma and would benefit from more structured instruction and closer supervision of ICD insertion.
确定在创伤患者中放置肋间胸腔引流管（ICD）时遇到的插入和定位并发症，以及在一级创伤单元以外的环境中插入肋间胸腔引流管的操作人员是否需要进一步培训。
在3个月的时间里，纳入泰格堡医院前室创伤区所有有或没有原位ICD的患者。直接通过创伤复苏单元入院的患者被排除。不包括长期感染并发症。采用自我报告系统记录并发症，并通过查阅科室记录和月度统计数据获取其他数据。
研究期间，在前室创伤区共诊治3989例创伤患者；273例（6.8%）原位有ICD或需要ICD的患者在创伤单元接受评估并入住胸腔引流病房；24例患者被确定有26例与ICD插入和定位有关的并发症；其中22例（92%）是带着原位ICD转诊的。总体并发症发生率为9.5%。插入并发症有7例（27%），定位并发症有19例（73%）。最常见的错误是在错误的解剖部位插入，以及胸外和放置过浅（引流管侧孔位于胸腔外）。
转诊医院的操作人员在胸部创伤ICD插入技术方面接受的培训不足，更多结构化的指导和对ICD插入的密切监督将使他们受益。
