Major Complications of Chest Tube Insertion

Life-Threatening Complications During Insertion

Penetration of major organs including lung, stomach, spleen, liver, heart, and great vessels are potentially fatal complications 1, 2, 3
These catastrophic injuries occur significantly more often when sharp metal trocars are inappropriately used during the procedure 1, 2
Never use a trocar or substantial force during insertion - this is the primary cause of organ injury 4
Use blunt dissection for large tubes (>24F) or Seldinger technique for smaller tubes instead 4

Never clamp a bubbling chest tube - this can convert a simple pneumothorax into a life-threatening tension pneumothorax 2, 3, 5
Even non-bubbling tubes should not usually be clamped 2, 3
If a clamped drain patient becomes breathless or develops subcutaneous emphysema, immediately unclamp and seek help 1, 2, 3

Empyema occurs in approximately 1% of chest tube insertions overall 1, 2, 3
In trauma cases, rates can reach 6% 1, 2, 3
Use strict aseptic technique during insertion and any manipulation of the drainage system 1, 2
Residual hemothorax significantly increases empyema risk (2-25% in trauma) 6

Develops when air communicates with subcutaneous tissues through a malpositioned, kinked, blocked, or clamped tube 1, 2, 3
Usually cosmetically important only and subsides in days 1, 5
Rarely causes acute airway obstruction or thoracic compression requiring emergency intervention (tracheostomy, skin decompression, or large bore subcutaneous drains) 1, 5

Always obtain a chest radiograph after insertion to verify position and rule out iatrogenic pneumothorax 4

Ensure proper tube function by checking patency by flushing with 20-50ml normal saline 6
Keep underwater seal drainage system below patient's chest level at all times 4
Perform imaging (chest X-ray or contrast-enhanced CT) if drainage is poor despite patent tube 6
For residual collections, place a second chest tube rather than relying solely on antibiotics 6
Consider intrapleural fibrinolytics (streptokinase 250,000 IU twice daily for 3 days or urokinase 100,000 IU once daily for 3 days) 6