Evaluation of Practice Guideline for Pneumothorax, Hydrothorax or Hemothorax in Patients Undergoing Percutaneous Nephrolithotomy in Srinagarind Hospital, Khon Kaen Province

Abstract

Background and objective: Percutaneous nephrolithotomy (PCNL) is gaining popularity because of its advantages i.e., smaller wounds, less pain and shorter hospital stay, nevertheless, pneumothorax, hydrothorax or hemothorax cannot be avoided.  Our department developed and promulgated a practice guideline (CPG) for prevention and management of these conditions in May 2012.  The objective of our study is to evaluate this CPG for its effectiveness and use the information to improve the CPG for continuous quality improvement.

Methods: This is a prospective, descriptive study.  We recruited all cases of PCNL performed after implementation of the CPG between October 2012 and September 2013 in Srinagarind hospital.

Results:  There were 66 cases of PCNL with 11 cases of pneumothorax, hydrothorax or hemothorax.  The incidence is 16.7%.  Most of the cases were females, aged more than 15 years, and with supracostal access.  Hydrothorax was 81.8% of the incidents.  Eight cases had mild symptom while the other three cases need intercostals drainage.  There was one case which the anesthetic personnel did not comply with the CPG and this patient was reintubated during PACU admission.

Conclusions: The CPG facilitates the diagnosis and treatment of pneumothorax, hydrothorax or hemothorax in patients undergoing PCNL. Supracostal access is the contributing factor.   Most of the cases had mild symptoms.  Since some personnel did not comply with the CPG, reinforcement is needed.