title: Intercostal catheter insertion: are we really doing well?
abstract: BACKGROUND
  Intercostal catheters (ICC) are the standard management of chest trauma, but are associated with complications in up to 30%. The aim of this study was to evaluate errors in technique during ICC insertion to characterize the potential benefit of improved training programmes.
  
  
  METHODS
  Prospective audit of all ICC in trauma patients at a level 1 trauma centre for over 12 months. Exclusions were pigtail catheters and ICC inserted during thoracic surgery. Errors were identified from patient examination and chest imaging; they were defined as insertional, positional, incorrect size (<28 French) and lack of antibiotic prophylaxis. Ongoing complications unrelated to an error in technique, for example blocked tube, were not analysed.
  
  
  RESULTS
  Fifty-seven patients received a total of 94 ICC during the study period. Patients were predominantly male (77%), mean age of 40 ± 20 years, mean injury severity score 27 ± 13, mean abbreviated injury scale chest 3.8 ± 0.72. 86% were blunt trauma and 14% penetrating chest injuries. Thirty-six errors in technique occurred in 33 ICC insertions (38%). The most common errors were absence of prophylactic antibiotics (13%), ICC too far out (9%), kinked (6%) and wrong-sized ICC (5%). Emergency had a significantly greater frequency of errors than other specialties (67%, relative risk 2.11, P= 0.002). The majority of ICC were inserted by registrars, and registrars made a greater number of errors than fellows or consultants (relative risk 2.00, P= 0.02).
  
  
  CONCLUSIONS
  This study identified a large number of preventable errors for ICC insertion in trauma patients. Standardized institutional credentialing systems may be required to ensure adequate proficiency of trainees performing this procedure.
authors.affiliation: Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia.
authors.forename: Rashid
authors.initials: R
authors.lastname: Alrahbi
authors.forename: Ruth
authors.initials: R
authors.lastname: Easton
authors.forename: Cino
authors.initials: C
authors.lastname: Bendinelli
authors.forename: Natalie
authors.initials: N
authors.lastname: Enninghorst
authors.forename: Krisztian
authors.initials: K
authors.lastname: Sisak
authors.forename: Zsolt J
authors.initials: ZJ
authors.lastname: Balogh
mesh_terms: D000328:Adult; D015505:Chest Tubes; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008485:Medical Audit; D019300:Medical Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D009517:New South Wales; D010995:Pleural Diseases / Q000209:etiology / Q000601:surgery; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013898:Thoracic Injuries / Q000150:complications / Q000601:surgery*; D013907:Thoracostomy / Q000295:instrumentation / Q000592:standards*; D014193:Trauma Centers / Q000592:standards* / Q000706:statistics & numerical data