Department of Respiratory Medicine, Salford Royal University Hospital, Stott Lane, Salford M6 8HD, UK.
Postgrad Med J. 2010 Feb;86(1012):68-72. doi: 10.1136/pgmj.2009.087759.
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.
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.
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.
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.
英国国家患者安全局报告了多起因使用肋间胸腔引流管（ICD）导致的死亡和严重伤害事件，此后我们对胸科医生进行了一项全国性调查，以了解他们在 2003 年至 2008 年期间与 ICD 相关的伤害经历。
我们向 148 家急症医院信托机构的 198 位英国胸科医生发送了一份问卷，询问他们在 2003 年至 2008 年期间与胸腔引流管相关的当前实践和任何不良事件。
148 家信托机构中有 101 家（68%）做出了回应。67 家信托机构报告了至少一起与 ICD 插入相关的重大事件。报告了 31 例 ICD 错位病例，其中 7 例死亡。错位的引流管被插入肝脏（10 例）、腹膜腔（6 例）、心脏（5 例）、脾脏（5 例）、锁骨下血管（2 例）、结肠（1 例）、食管（1 例）和下腔静脉（1 例）。报告了 47 例严重的肺部或胸部壁损伤，其中 8 例死亡，6 例 ICD 放置在错误的一侧，其中 2 例死亡。在 3 例病例中导丝丢失在胸腔内。在 101 家信托机构中有 22 家在插入 ICD 之前需要书面患者同意。11 家信托机构有培训政策。16 家信托机构有该程序的患者信息文献。允许插入 ICD 的医生的资历如下：30%任何医生；27%至少在资格后 1 年；32%至少 2 年，11%至少 4 年。
67%的回应信托机构遇到了 ICD 的主要并发症。该调查引起了对培训和同意的关注。英国国家患者安全局已提出建议以解决这些风险，这些建议也在 2009 年英国胸科学会胸腔疾病指南更新中得到了体现。
