ICD insertion is a commonly done procedure in respiratory wards and in emergency and medical admission departments. There were number of reported cases of serious complications in UK associated with this procedure and we want to share our experince in 52 patients who had undergone ICD insertion.
Details of all ICD insertions were collected on a daily basis by a designated Consultant in Chest Medicine over a five months period.This observational study looked at the indications,use of imaging prior to ICD insertion and complications associated with it.
Over the five months period , 52 patients had undergone intercostal chest drain insertions.Out of these 18 ICD insertions were for pneumothorax (34.61 %) and 34 ICD insertions were for pleural effusions (65.38 %). Most of the ICD insertions were performed in respiratory wards (25), 48.07 % ,medical admission ward (10), 19.23 % and emergency admissions (9), 17.30 %. Out of the 34 patients with Pleural effusions, 31 patients (91.17 %) had radiological imaging to confirm pleural effusion prior to ICD insertion. The 3 out of the 34 patients (8.82 %) who had ICD without prior radiological imaging were done in suspected empeyma in emergency admission department. Two ICD insertions performed in emergency department, for symptomatic pneumothorax were complicated by infection of the pleural space with staphylococcus aureus. No other major complications occured in the remaining 50 patients. Initial ICD fell out in 8 patients needing further ICD insertions (15.38 %).
ICD insertion is a safe procedure in experienced hands.Prior imaging with ultra sound scan of the chest to localise fluid in case of suspected pleural effusions can significantly minimise major complications as shown from our experience.Careful aseptic precaution is vital in emergency ICD insertion to prevent serious intra pleural sepsis.
There is a need to improve education and training in ICD insertion, with special emphasis on aseptic precaution and securing the drains properly to prevent drain displacement.
Ajikumar Kavidasan, No Financial Disclosure Information; No Product/Research Disclosure Information