Complications of chest drains in palliativepatients : prevention and management

Abstract: Introduction: Pleural diseases causing pleural effusions requiring intervention are increasing.Pleural effusions are often treated by thoracentesis or chest drains. Despite being commonprocedures there is a lack of consensus regarding guidelines of these procedures. The BritishThoracic society’s (BTS) guidelines are widely accepted yet lack evidence. Aim: The aim of this study was to perform a quality control of the current guidelines of chestdrains at USÖ, to investigate possible correlation between volume drained and occurrence ofcomplications, to chart occurrence of chest drain related complications at USÖ’s palliativecare ward during 2020 and 2021 and to analyze sex-specific differences regarding chest drainmanagement and complications. Method: A retrospective medical journal review of patients’ who underwent chest drains in2020 and 2021 was conducted. Results: 66 chest drains were managed in which 4 hypotensive episodes and 2 pulmonaryemboli were reported. Common complications were bleeding and pain. There were 2 reportsof pulmonary emboli, but of no other serious complications such as pneumothorax, reexpansionpulmonary edema (REPE) or empyema. Conclusion: There was no statistically significant association between drainage of greatervolumes and complications. However, pain and hypotension developed more frequentlywhen >500ml was removed. Females more frequently developed pain and hypotension. Chestdrains remain a safe intervention for treatment of pleural effusions, with low rates of seriouscomplications. The risk of developing serious complications following drains >500ml, withina reasonable range, seem to be low why drains exceeding 500ml could be relevant in order tohastily achieve symptomatic relief.