Iatrogenic Pneumothorax Conservative Management — FRCA Final MCQ

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ModerateAnaesthetic Equipment & SafetyIatrogenic Pneumothorax Conservative ManagementFRCA Final

A 42-year-old man (ASA I) develops a pneumothorax during subclavian vein central line insertion. CXR shows a 3 cm rim pneumothorax. He is on room air with SpO2 97% and is asymptomatic. According to BTS guidelines, what is the initial management?

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Correct answer: E — High-flow oxygen and observation with repeat CXR in 4-6 hours

BTS guidelines (2023) for iatrogenic pneumothorax: if the patient is NOT breathless and the pneumothorax is small-moderate, observation with high-flow oxygen (if no contraindication) and repeat CXR in 4-6 hours is appropriate. Oxygen accelerates pneumothorax resolution by creating a gradient for nitrogen absorption. If the patient is breathless or the pneumothorax is large/tension, needle aspiration followed by chest drain if aspiration fails is indicated. Most iatrogenic pneumothoraces from CVC insertion can be managed conservatively.

Reference: BTS – 2023 – Pleural disease guidelines; RCOA – 2023 – Vascular access complications