Complications - Tube thoracostomy, open - general and visceral surgery
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Particularly when inserting the chest tube with a stylet, this can easily injure the pulmonary parenchyma. If the injuries are small, they often go unnoticed. However, injuries to the pulmonary parenchyma may result in significant bleeding complications which may only be controlled by surgical hemostasis (emergency thoracoscopy or thoracotomy). Therefore, it is best to insert the chest tube without a stylet.
Injury to intercostal nerves and vessels
This complication can be avoided by always dissecting strictly along the upper aspect of the rib and avoiding any contact with the inferior aspect of the rib immediately superior because the intercostal vessels and nerves course there. However, this is often difficult, especially in thin patients and with large-caliber chest tubes. In these situations, special caution is therefore advised and, if necessary, a different thoracostomy site with a taller intercostal space should be sought. In case of any bleeding despite these precautions, extend the skin incision and place a suture ligature around the vessel.
Injury to intraabdominal or intrathoracic organs
If the thoracostomy site is too far caudad, this may result in accidental penetration of the peritoneal cavity and organ injuries.
Left tube thoracostomy may injure the heart as the pericardium can extend to the lateral chest wall.
Perforation of the diaphragm
Inappropriate handling may perforate the diaphragm with the chest tube or stylet, resulting in organ perforation and bleeding. For this reason, avoid inserting the chest tube with the stylet. Surgical management is indicated for diaphragmatic injuries.