Indications, Promptness Of Insertion And Removal Of Chest Tubes In Patients At Kenyatta National Hospital.
Abstract
Background: Currently in Kenya there is increased motorization with a rise in road traffic
accidents which predispose people to blunt chest injuries or penetrating chest injuries hence an
increased likelihood of the need of a tube thoracostomy. Advances in medical practice have
resulted in a rise in the diagnosis of malignancies as well as other respiratory medical conditions
and infections with complications that may warrant insertion of chest tubes. Findings on the
indications for chest tube insertion, time to insertion and removal of chest tubes will therefore aid
in auditing the management of patients who require tube thoracostomy.
Objective: To establish the indications, promptness of insertion and removal of chest tubes in
patients at Kenyatta National Hospital (KNH).
Study design: Prospective descriptive study done at KNH in the Accident and Emergency
department, General Surgical, Cardiothoracic and Medical wards from December 2017 to May
2018.
Study Population: All patients above 18 years at Kenyatta National Hospital who had tube
thoracostomy and gave consent to participate in the study.
Methodology: Ethical approval was obtained from the KNH/UON Ethics and Research Review
Committee. Patients were selected by convenience sampling. Informed and signed consent was
obtained from patients. Patient case notes were examined and the following information was
entered into a data sheet: patient bio data, indication for chest tube insertion, time to insertion
and time to removal, site of insertion, the size of catheter used, duration chest tube stayed in-situ,
and the outcomes in terms of hospital stay and death. The data was analyzed using SPSS version
22.
Mean, median and as well as ranges, proportions and ratios were employed in analysis.
Categorical data was analyzed using Chi square test and a p value < 0.05 was considered
significant. The results were presented in tables, bar charts, pie charts and graphs.
xiv
Results: There were 125 patients reviewed after chest tube insertion between December 2017
and May 2018. Out of these, 55.2% of the chest tube insertions were due to non-trauma medical
conditions and 44.8% were due to chest trauma. The time to insertion of chest tube after doctors`
review was within one hour in majority of the cases. The time to removal of chest tube after the
doctors` review was 7-12 hours, accounting for 62.7% of all the patients.
Three-quarters (75.4%) of the patients had the chest tube remain in situ for a period of 1-14 days.
The median length of hospital stay was 9 days for trauma patients and 20 days for non-trauma
cases. The mortality rate of patients undergoing chest tube insertions due to trauma causes was
5% and 95% survived, while for non-trauma cases it was 22% with 78% of patients surviving.
Conclusion: Non-traumatic conditions constituted the majority of indications for chest tube
insertions compared to trauma indications. Time to insertion of chest tube was within one hour
after doctors’ review which is in keeping with the ATLS guidelines.
Recommendations: Investing in a well-equipped trauma bay at the Accident and Emergency
department at KNH will allow proper management of trauma cases and application of ATLS
guidelines and protocols to the later.
Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
The following license files are associated with this item: