Outpatient Management of A Spontaneous Pneumothorax

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.[1]


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.

Read all articles in Cardiovascular diseases, Chest Tube, Emergency Procedures, Featured Procedure, medical procedures, Procedural Sedation, Respiratory diseases
Tags: chest tube, featured procedure, HPC updates, pneumothorax, tube thoracostomy

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