Lung Injury
Especially when placing the drainage with the guide rod, injuries to the lung parenchyma can easily occur. If they are minor injuries, they often remain unnoticed. However, injury to the lung parenchyma can lead to significant bleeding complications, which can only be resolved by surgical hemostasis (emergency thoracoscopy or -tomy). Therefore, inserting the drainage without a guide rod is preferable.
Injury to Intercostal Nerves and Vessels
To avoid this, the preparation should always be carried out strictly at the upper edge of the rib and contact with the lower edge of the overlying rib should be avoided, as the intercostal vessels and nerves are located here. Especially in slender patients and with large-lumen drainages, this is often difficult. Therefore, special caution should be exercised here and, if necessary, another puncture site with a larger ICR should be sought. If bleeding occurs nonetheless, the skin incision should be extended and the vessel ligated with a transfixion suture.
Injury to Intra-abdominal or Intrathoracic Organs
If the puncture site is chosen too low, accidental entry into the abdominal cavity can occur, which can lead to organ injuries.
If entry is on the left side, heart injury can occur, as the pericardium can extend to the lateral thoracic wall.
Diaphragm Perforation
With improper handling, it can happen that the diaphragm is perforated with the drainage or the guide rod, leading to organ perforation and bleeding. For this reason, inserting the drainage with the trocar should be avoided. In case of diaphragm injury, surgical treatment is indicated.