Medical oncology (MO) patients may require insertion of chest drains for symptomatic management of malignant pleural effusions and/or diagnostic purposes. This may be associated with significant morbidity. This audit aims to investigate the rate and type of chest drains complications in MO inpatients at a tertiary hospital.
A key terms search of electronic medical records identified MO patients with chest drains from January to July 2020. Records were manually reviewed for data collection. Descriptive statistical analysis was performed.
26 chest drains were inserted in 20 MO inpatients by respiratory, cardiothoracic, interventional radiology and critical care teams. Three patients required multiple drains. All patients had metastatic disease with drains inserted for symptomatic exudative pleural effusions, with 85% known to palliative care. Ultrasound guidance insertion occurred in 80% of cases and a post-insertion chest x-ray was always performed. The majority (69%) of patients were managed on the MO ward and the remainder in respiratory, cardiothoracic and critical care areas. Chest drains remained in situ for a median of 4 days (range of 1-17). All patients received ongoing reviews by respiratory/cardiothoracic teams. Complications occurred in 18 (69%) chest drains. The most common complication was drain blockage (12 blockages in 6 drains), with others including pneumothorax (n=9, 35%), pain (n=6, 23%), infection (n=2, 8%), drain disconnection (n=2, 8%), procedural vasovagal (n=2, 8%) and bleeding (n=1, 4%).
Chest drain complications were common and broad in nature in MO patients. Risk factors such as high disease burden, complex analgesia requirements, immunocompromised status and large, recurring malignant effusions are hypothesised to increase the rate of complications warranting further research.