Complica tions

• Morbidity associated with chest drainage may be up to 10%.

• Puncture of intercostal vessel may cause significant bleeding. Consider (i) correcting any coagulopathy, (ii) placing deep tension sutures around drain or (iii) removing drain, inserting a Foley catheter, inflating the balloon and applying traction to tamponade bleeding vessel. If these measures fail, contact (thoracic) surgeon.

• Puncture of lung tissue may cause a bronchopleural fistula. If chest drain suction (up to 15-20cmH2O) fails, consider (i) pleurodesis (e.g. with tetracycline), (ii) high frequency jet ventilation ± double-lumen endobronchial tube, or (iii) surgery. Extubate if feasible.

• Perforation of major vessel (often fatal) — clamp but do not remove drain, resuscitate with blood, contact surgeon, consider double-lumen endotracheal tube.

• Infection — take cultures; antibiotics (staphylococcal ± anaerobic cover); consider removing/resiting drain.

• Local discomfort/pain from pleural irritation may impair cough. Consider simple analgesia, subcutaneous lidocaine, instilling local anaesthetic, local or regional anaesthesia, etc.

• Drain dislodgement — if needed, replace/resite new drain, depending on cleanliness of site. Don't advance old drain (infection risk).

• Lung entrapment/infarction — avoid milking drain in pneumothorax.

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