Diagnostic and Therapeutic Algorithm for Splanchnic Injuries Caused during Chest Tube Insertions

Abstract

Introduction: Chest tube insertion is a frequent surgical procedure that can have serious complications, which depend mostly on the practitioner’s experience, the tube’s size and the use of imaging to guide the insertion.

Objective: To describe the main splanchnic injuries caused during chest tube insertion, as well as to present algorithms for early diagnosis and timely treatment of these types of iatrogeny.

Methods: A descriptive narrative review was performed during the first quarter of the year 2023. The electronic databases PubMed, LILACS, EBSCO and Cochrane were used. Articles published from 1984 to 2022 were reviewed. Most of the information was secured to be framed within a period of no more than 10 years.

Development: Among the splanchnic injuries within the thoracic cavity, lung injury is the most frequent and may lead to bleeding or persistent air leak. Vascular injuries are severe and can lead to death if appropriate measures are not taken. Injuries to hollow organs of the abdominal cavity have been described to be usually part of a diaphragmatic hernia. Among the most frequent splanchnic lesions within the abdomen are the hepatic and splenic injuries.

Conclusions: These lesions are preventable and their mechanism of production should be taken into account in order to avoid them. To achieve this, we recommend that the insertion site be carefully selected and that the tube’s position be adequately confirmed, as well as the careful handling of the tube and the constant monitoring of the patient.