Abstract
Objective: To describe possible complications of thoracostomy tube insertion and common pitfalls regarding the management of the under water seal system.
Methods: This descriptive study was conducted at King Hussein Medical Center of the Royal Medical Services between December 2006 and January 2008. Two hundred twenty four patients were included in this study with 339 tube insertions. Complications related to the thoracostomy tube insertion and mistakes practiced by the medical staff regarding the management of thoracostomy tube and its system were documented and analyzed.
Results: There were 131 males (58.5%) and 93 females (41.5%). Age ranged from 15 to 86 years (mean 41±10.11). One hundred seventy one thoracostomy tubes (50.4%) were inserted in the operating theater post thoracotomy or thoracoscopic surgery, 99 (29.2%) were inserted in the intensive care unit and surgical wards, while 69 (20.4%) were inserted in the emergency department. The most common complications related to chest tube insertion were lung injury followed by intercostal vessels injury. The commonest mistakes related to the care of thoracostomy tube and its system were tube clamping during the transport of the patients, and improper handling of the negative suction system connected to the chest bottle.
Conclusion: All the complications related to chest tube insertion resulted from the trocar. Mistakes in dealing with the tube and its system were common. All physicians working in the surgical field, in particular general surgery residents and nurses should have special courses in chest tube management and care. (Rawal Med J 2008;33:141-144).

Key words: Thoracostomy tube, complications, pitfalls