A patient with a hemodynamically stable spontaneous pneumothorax can be managed as an outpatient using the placement of a small-bore pigtail catheter attached to a Heimlich valve.
As the Director of Medicine at a teaching hospital, I frequently encounter patients who have undergone traditional tube thoracostomy with the chest tube connected to a Pleur-Evac container for a simple, uncomplicated pneumothorax. This is not only an unnecessary admission, but the patient often endures excessive discomfort during traditional chest tube placement and will be left with a much larger scar than is necessary.
All that is needed for an uncomplicated pneumothorax (even a large pneumothorax), is a small pigtail catheter and a Heimlich valve (e.g., a Wayne Pneumothorax Evacuation Kit). Unlike traditional chest tube insertion, procedural sedation is usually not needed for pigtail catheter insertion.
The pigtail catheter can be inserted in the mid-clavicular line of the second intercostal space or in the mid-axillary line using a generous amount of local anesthesia. The catheter is then connected to a Heimlich valve (Figure 1) and the patient can be sent out from the emergency department. They are instructed to keep the Heimlich valve dry and to return daily for chest x-rays until the lung is fully inflated at which time the catheter is removed.
Figure 1: Pigtail catheter connected via tubing to a Heimlich valve.
Copyright 2014, Hospital Procedures Consultants.
Hassani, B et al. Outpatient Management of Primary Spontaneous Pneumothorax in the Emergency Department of a Community Hospital Using a Small-bore Catheter and a Heimlich Valve. Academic Emergency Medicine. 2009; 16: 513-518.