title: Indications and complications of tube thoracostomy with improvised underwater seal bottles.
abstract: BACKGROUND
  Tube thoracostomy is a lifesaving and frequently performed procedure in hospitals where the expertise and necessary tools are available. Where the ideal drainage receptacle is unavailable, the underwater seal device can be improvised with bottled water plastic can especially in emergency situations.
  
  
  OBJECTIVE
  To determine the frequencies of the various indications and complications of tube thoracostomy with improvised underwater seal.
  
  
  METHODS
  A cross-sectional study with a structured proforma was used for assessment over a 3-year period (May 2010-April 2013). The proforma was filled at the time of the procedure by the performing surgeon and patients were followed up with serial chest X-rays until certified cured. A 1.5 L bottled water container was used as the underwater seal receptacle. The data was analysed with SPSS 15 software program.
  
  
  RESULTS
  A total of 167 patients were managed. There were 106 (63.5%) males and 61 (36.5%) females. The mean age was 34.85 ± 16.72 with a range of 1-80 years. The most frequent indication was for malignant/paramalignant effusion, 46 (27.5%). Others were trauma, 44 (26.3%), Parapneumonic effusion, 20 (12%), postthoracotomy 14 (8.4%), empyema thoracis 12 (7.2%), heart disease and tuberculous effusion 11 (6.6%) each, pneumothorax 8 (4.8%) and misdiagnosis 1 (0.6%). A hundred and one (60.5%) of the procedures were performed by registrars, 41 (24.6%) by consultants, house officers 15 (9%) and senior registrars 10 (6%). The overall complication rate was 16.8% with the more frequent complications been empyema (5.6%) and pneumothorax (3.6%). The average duration of tube placement was 13.02 ± 12.362 days and range of 1-110 days.
  
  
  CONCLUSIONS
  Tube thoracostomy can be a relatively safe procedure with acceptable complication rates even with improvised underwater seal drainage bottles.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Ahmadu Bello University, Zaria, Nigeria.
authors.forename: Sunday A
authors.initials: SA
authors.lastname: Edaigbini
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Ahmadu Bello University, Zaria, Nigeria.
authors.forename: Ibrahim Z
authors.initials: IZ
authors.lastname: Delia
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Ahmadu Bello University, Zaria, Nigeria.
authors.forename: Muhammad B
authors.initials: MB
authors.lastname: Aminu
authors.affiliation: Department of Paediatrics, Cardiopulmonary Division, Ahmadu Bello University, Zaria, Nigeria.
authors.forename: Abosede A
authors.initials: AA
authors.lastname: Orogade
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Ahmadu Bello University, Zaria, Nigeria.
authors.forename: Ndubuisi
authors.initials: N
authors.lastname: Anumenechi
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Ahmadu Bello University, Zaria, Nigeria.
authors.forename: Ibrahim D
authors.initials: ID
authors.lastname: Aliyu
keywords: Complications; improvisation; indications; tube thoracostomy