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.