Abstract

Background: Tube thoracostomy is defined as insertion of a tube (chest tube) into the pleural
cavity to drain air, blood, bile, pus, chyle or other fluids The present study was conducted to
compare tube thoracostomy in triangle of safety versus outside the triangle of safety.
Material and methods: This study was multiple centre prospective comparative study
conducted in department of Surgery. A total of 69 patients were included in study,
randomized into two groups, tube thoracostomy in safe triangle (n=35) and tube
thoracostomy outside safe triangle (n=34). All cases were carefully worked up in terms of
detailed history and clinical examination. Lab and imaging intervention included.
Results: It was observed that major lung conditions for which the tube thoracostomy done in
triangle of safety, improved rapidly and earlier in comparision to tube thoracostomy done
outside the triangle of safety. Pneumothorax, Hemothorax, Hemopneumothorax, Empyema,
Chylothorax, Hydrothorax and Pleural effusion improved rapidly and earlier when tube
thoracostomy was done in triangle of safety. However, group of patients having similar
indications for tube thoracostomy but done outside safety triangle, improved slowly and
delayed. It was observed that major complications of tube thoracostomy as either technical or
infective. Technical complications include –Tube malposition, Blocked tube, Chest drain
dislodgement, Reexpansion pulmonary oedema, Subcutaneous emphysema, Nerve injury,
Cardiac and vascular injuries, Oesophageal injuries, Fistula, Tumor recurrence at insertion
site, Herniation through the site, Chylothorax and cardiac dysrhythmia. Infective
complications include Empyema and Surgical site infection including cellulitis and
necrotizing fasciitis. All above mentioned complications except few one were more frequent
when tube thoracostomy was done outside safety triangle in comparison to tube thoracostomy
in triangle of safety. Tube malposition is the commonest complication of tube thoracostomy.
Intraparenchymal tube placement occurs more likely in the presence of pleural adhesion.
Blocked tube may be due to kinking, angulation or clot formation. Subcutaneous emphysema
associated with trauma, bronchopleural fistula, large and bilateral pneumothoraces, prolonged
drainage and tube blockage.