Outcomes of an initiative to improve inpatient safety of small bore thoracostomy tube insertion

Conceição Santos*, Saurabh Gupta, Melissa Baraket, Peter J. Collett, Wei Xuan, Jonathan P. Williamson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
33 Downloads (Pure)


Background: Intercostal chest catheter (ICC) insertion is a common hospital procedure with attendant risks including life-threatening complications such as pneumothorax and visceral damage. Aim: To investigate the effect of a quality improvement (QI) initiative on complications associated with inpatient thoracostomy tube insertion. Methods: Following an audit of ICC complications in inpatients over a 2-year period we implemented a comprehensive QI programme. This involved formal training in and mandatory use of thoracic ultrasound, standardisation of the procedure and documentation, a dedicated procedure room with nurses trained in assisting ICC insertion and senior supervision for medical staff. An audit over 2 years post-implementation of the QI protocol was compared with pre-implementation results. Results: A total of 103 cases were reviewed pre-implementation and 105 cases were reviewed post-implementation of the QI programme. All procedures following the QI initiative were image guided compared to 23.3% of cases pre-implementation. The rate of developing a pneumothorax requiring intervention post-implementation was less than pre-implementation (1.9% vs 5.8% (P = 0.023). Post-implementation, there were no instances of dry taps, viscera perforation, clinically significant bleeding or wrong side ICC insertion and documentation improved. Conclusion: QI initiative applied to thoracostomy tube insertion in hospital inpatients can reduce complications and improve procedure documentation.

Original languageEnglish
Pages (from-to)644-649
Number of pages6
JournalInternal Medicine Journal
Issue number5
Publication statusPublished - 1 May 2019
Externally publishedYes

Bibliographical note

Copyright the Author(s) 2018. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


  • complication
  • intercostal thoracostomy tube
  • pneumothorax
  • quality improvement
  • thoracic ultrasound


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