Tale of a Blocked Chest Drain Resulting in Tension Pneumothorax: Are We Always Competent Enough to Troubleshoot a Chest Drain?

Intercostal chest drain (ICD) insertion for pleural effusion or pneumothorax is one of the most routinely performed procedures. Patients with ICDs usually remain in a respiratory, medical, or cardiothoracic ward or a critical care unit. Despite it being a common procedure, there seems to be limited competency in troubleshooting chest drain when it is not functioning. From our daily experience working with junior doctors and doctors from specialties other than respiratory medicine, we feel there is a significant lack of training and troubleshooting skills to handle a non-functioning chest drain. This is a matter of grave concern, as inappropriate assessment can lead to the insertion of additional chest drains. In the current practice in the United Kingdom, we do not have out-of-hours respiratory cover, particularly in the district general hospitals, and the on-call medical team will not always have a registrar or any other team member with respiratory work experience. Therefore, we often fall short of managing ICD-related complications which results in the incorrect assessment of the patient's condition further leading to incorrect action plans, causing more harm to the patient. We present one such case, where a young pregnant lady in the respiratory ward who underwent thoracostomy with an ICD placement developed a near-tension pneumothorax secondary to block in the drain. The medical team's inexperience in troubleshooting led to a wrong treatment plan for the patient. Although ICD-related complications are frequent, very few reviews and guidelines are available in the literature which covers it comprehensively. Therefore, we aim to enlighten this less-explored area of clinical practice along with a review of literature.