Psi 10 postoperative acute kidney injury requiring dialysis rate. Selected best practices and suggestions for improvement psi 6. Pneumothorax may be classified as open or closed and as traumatic, spontaneous, or iatrogenic. While secondary pneumothorax is caused by an underlying pulmonary disease, the spontaneous type occurs in healthy individuals without obvious cause. Reduction in iatrogenic pneumothorax journal of hospital. Spontaneous pneumothorax is a significant health problem because of the high recurrence rate this is so called recurrent pneumothorax. Riskadjusted complication rate per 100 admissions 0. Sonosite is primed to come to the aid of those seeking the training and equipment needed to reduce their pneumothorax. Pneumothorax can be categorized as primary, secondary, iatrogenic or. Iatrogenic pneumothorax occurs secondary to invasive procedures such as transthoracic needle biopsy 50%, subclavian line placement 25%. Surgical or medical discharges for medicare ffs beneficiaries ages 18 years and older. Without appropriate treatment, the impaired venous return can cause systemic hypotension and. This signs and symptoms information for iatrogenic pneumothorax has been gathered from various sources, may not be fully accurate, and may not be the full list of iatrogenic pneumothorax signs or iatrogenic pneumothorax symptoms.
When patients with an open pneumothorax inhale, the negative intrathoracic pressure generated by inspiration causes air to flow into the lungs through the trachea and simultaneously into the intrapleural space through the chest wall defect. Spontaneous pneumothorax is often a result of bullous emphysema, and iatrogenic pneumothorax is an important complication of procedures involving the thoracic cavity. Pneumothorax, iatrogenic statpearls ncbi bookshelf. Medicare announces new hospitalacquired condition hac iatrogenic pneumothorax during venous catheterization medicares recent ruling can significantly impact hospitals that havent yet embraced ultrasound needle guidance during central line placements. Iatrogenic pneumothoraces is a potentially lifethreatening. The most common cause of pneumothorax is thoracic trauma.
The length of stay can be increased by an average 4. Iatrogenic pneumothorax related to mechanical ventilation. Iatrogenic pneumothorax it depends on the circumstances in which it develops table 1. The leading causes of iatrogenic pneumothorax were transthoracic needle aspiration 128, subclavicular needle stick 119, thoracentesis 106, transbronchial biopsy 54, pleural biopsy 45 and positive pressure ventilation 38. If the lesion is deeper and the size is smaller chances of traumatic pneumothorax increases.
Managing iatrogenic pneumothorax and chest tubes request pdf. Spontaneous and iatrogenic pneumothorax anesthesia. Progressive iatrogenic pneumothorax from incorrectly. Iatrogenic pneumothorax ip is a lifethreatening complication seen in 3% of icu patients. Pneumothorax can be categorized as primary, secondary, iatrogenic or traumatic according to etiology. The pleural space is a cavity formed by the two pleural membranes that line the thoracic cavity and cover the lungs. Iatrogenic pneumothorax has become an increasingly recognized complication of routine outpatient procedures, such as transthoracic needle biopsies of the lung and transbronchial lung biopsies. An iatrogenic pneumothorax occurs when air enters the pleural space during a.
History of prior pneumothorax is common since 20% to 30% of patients experience recurrence. Iatrogenic pneumothorax is a patient safety indicator psi of the above procedures. Because of incomplete data, 3 iatrogenic pneumothoraces reported from one center were excluded. Pneumothorax is an abnormal collection of air in the pleural space, which causes a separation of the visceral pleura from the parietal pleura and partial to complete collapse of the lung. Iatrogenic pneumothorax why focus on iatrogenic pneumothorax. Iatrogenic pneumothorax is a traumatic pneumothorax that results from injury to the pleura, with air introduced into the pleural space secondary to diagnostic or therapeutic medical intervention see the following image.
Psi06 excludes encounters for chest trauma and thoracic or cardiac procedures as pneumothoraces are inherent to the risk associated with chest injuries and thoracic procedures. Ahrq quality indicators toolkit selected best practices. An iatrogenic pneumothorax occurs when air enters the pleural space during a medical treatment or procedure, such as mr. Placement of chest tube with resolution of the pneumothorax. Coding for postprocedural pneumothorax california health. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. Iatrogenic pneumothorax secondary to insertion of a port.
Two factors may be responsible for it, depth and size of the lesion. Half a century ago, iatrogenic pneumothorax was predominantly the result of deliberate injection of air into the pleural. Simple manual aspiration as firstline treatment of psp. Incidence of iatrogenic pneumothorax in the united states. Traumatic pneumothorax may result from either blunt trauma or penetrating injury to the chest wall. Psi06 focuses on cases with a secondary diagnosis icd10cm. Pdf we discuss the etiology and incidence of iatrogenic pneumothorax ipnx which can develop after invasive procedures performed for diagnostic. Pneumothorax lung physiology pulmonary medicine youtube. A high index of suspicion is needed consider the diagnosis in case of. The leading cause of iatrogenic pneumothorax is transthoracic needle aspiration.
Iatrogenic pneumothorax insertion of central line with ultrasound guidance and simulation training retained foreign object rfid tags on sponges, preclose pause and end of case debrief ssi chqi collaborative sepsis bundle nurse driven protocol, nurse champions, simulation training, screening. Iatrogenic pneumothorax iap is a complication of invasive procedures that is associated with substantial morbidity and some mortality. Pdf managing iatrogenic pneumothorax and chest tubes. It carries a bad prognosis, particularly if the chest drain cannot be rapidly removed. Some patients with traumatic pneumothorax have an unsealed opening in the chest wall. The most common risk factor for spontaneous pneumothorax is smoking, although chronic lung disease and infections are predisposing factors. Few reports on iatrogenic pneumothorax developed duringafter a. Iatrogenic tension pneumothorax developed during ventriculo. Primary spontaneous pneumothorax psp is defined as the. Pneumothorax can result from trauma, infection, lung disease, connective tissue. Uptodate, electronic clinical resource tool for physicians and patients that provides information on adult primary care and internal medicine, allergy and immunology, cardiovascular medicine, emergency medicine, endocrinology and diabetes, family medicine, gastroenterology and hepatology, hematology, infectious diseases, nephrology and. Medicaid and medicare services cms identified iatrogenic pneumothorax with venous catheterization as one of a number of conditions for which hospitals do. Furthermore, signs and symptoms of iatrogenic pneumothorax may vary on an individual basis for each patient.
Some ips may be asymptomatic and go undiagnosed, or their diagnosis may be delayed. Its management consists of noninvasive and invasive therapies and it is determined based on clinical manifestations, type and size of. Abstract pneumothoraxeither spontaneous or iatrogenicis commonly encountered in pulmonary medicine. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Psis were developed by the agency for healthcare research and quality ahrq to provide information about potential. Discuss concepts and reasons for assignment of complication codes explore the impact of reporting complication codes. Psi 12 perioperative pulmonary embolism or deep vein thrombosis rate. Tension pneumothorax is a pneumothorax causing a progressive rise in intrapleural pressure to levels that become positive throughout the respiratory cycle and collapses the lung, shifts the mediastinum, and impairs venous return to the heart. Pneumothorax, defined as the presence of air in the pleural space, is a serious complication of mechanical ventilation and is associated with increased morbidity and mortality1,2. If the patient is being ventilated with a manual selfinflating resuscitation. Iatrogenic pneumothorax rate qualifying discharges with any secondary icd10cm diagnosis codes for iatrogenic pneumothorax. This article is from tuberculosis and respiratory diseases, volume 76.
Secondary spontaneous pneumothorax also occasionally develops in critically ill patients, especially those with chronic obstructive pulmonary disease, asthma, interstitial lung disease, necrotizing lung infections, adult respiratory distress syndrome, and pneumocystis jiroveci pneumonia. It can occur spontaneously or following trauma, and is a common iatrogenic complication of multiple procedures. Inhospital fall with hip fracture rate qualifying discharges with any secondary icd10cm diagnosis codes for hip. On the flipside, someone who undergoes a medical procedure that causes pneumothorax is a victim of iatrogenic pneumothorax, or pneumothorax caused by a medical professional. Iap is often avoidable, and in many cases can be prevented through adherence to evidence. Cf guidelines pneumothorax management of pneumothorax in cystic fibrosis. The incidence of pneumothorax increases with age overall 8% and is a marker of severe lung disease. Selected best practices and suggestions for improvement. Quality measures fact sheet center for medicare and. The initial british thoracic society bts guidelines for the treatment of pneumothoraces were published in 1993.
Iatrogenic pneumothorax is a patient safety indicator psi representing a complication of procedures such as transthoracic needle aspiration, subclavicular needle stick, thoracentesis, transbronchial biopsy, pleural biopsy, and positive pressure ventilation. A pneumothorax occurs when the potential space between the parietal and visceral pleura of the lung. Any information contained in this pdf file is automatically generated from digital material submitted to. Iap may occur with a subclavian sc or internal jugular ij central venous. Box 691 lists the common causes of iatrogenic pneumothorax. Principles of diagnosis and management of traumatic. Accumulation of air or gas in the pleural cavity, occurring as a result of disease or injury, or sometimes induced to collapse the lung in the. Documentation and coding of complications 2 learning objectives at the completion of this educational activity, the learner will be able to. Pneumothorax, condition in which air accumulates in the pleural space, causing it to expand and thus compress the underlying lung, which may then collapse. Pneumothorax is the presence of air in the pleural space. Iatrogenic pneumothorax added to medicare hac list sonosite.
Outline classification of pneumothorax epidemiology pathophysiology and etiology clinical features radiological features management of spontaneous pneumothorax case based recommendations on air travel and diving. Selected best practices and suggestions for improvement psi 06. Different classifications are used to describe the various types of pneumothoraxes, though two major types commonly are. With picmonic, get your life back by studying less and remembering more. Pediatric quality indicator 05 pdi 05 iatrogenic pneumothorax rate june 2018 description iatrogenic pneumothorax cases secondary diagnosis per 1,000 surgical or medical discharges for patients ages 17 years and younger. Riskadjusted complication rate, 2014 diagnosis present on admission poa included in calculations, poa exempt hospitals excluded hospital patients 18 years and older better quality may be associated with lower rates.
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