Traditionally, traumatic hemothorax treatment called for the insertion of a 36-French (36F) to 40F large-bore chest tube (CT). In this article, we’ll delve into a study that shows how 14F percutaneous catheters (P-CATs or PCs) or pigtail catheters have equal efficacy as chest tubes with better outcomes for pain management.
But first, let’s learn what traumatic hemothorax and its symptoms are. This will help us understand the condition and its treatment better.
Hemothorax is a medical condition in which blood accumulates inside the pleural cavity (the cavity between the lungs and below the chest wall). In traumatic hemothorax, the condition arises from injuries to thoracic structures. These structures include the heart, lungs, chest wall, and other important organs and tissues.
The injuries may be blunt or penetrating and even minor, causing trauma to these structures. Traumatic injuries to the chest are one of the most common causes of hemothorax.
Traumatic hemothorax usually leads to the rupturing of the pleural membrane that lines the thoracic structures. Blood then flows into the pleural cavity that cannot be drained, putting pressure on the lungs.
Nowadays, emergency medical personnel immediately check a person’s lungs for symptoms of this medical condition after they experienced an accident, injury, cut, or wound that impacted the chest.
Signs and Symptoms of Traumatic Hemothorax
Here are the important signs and symptoms of traumatic hemothorax that you must look out for:
- Dyspnea or shortness of breath
- Reduced (or a lack of) breathing sounds
- Rapid, tense, or shallow breathing
- Chest pain
- Feelings of heaviness in the chest
- Reduced tactile fremitus (chest wall palpation that arises from sound vibrations from vocalization or speech)
- Rapid heart rate
- Low blood pressure
- Hemorrhagic shock (Reduced cellular oxygen delivery due to severe blood loss)
- Cold sweats
- High fever of over 100°F
- Pale, cold, or clammy skin
- Restlessness, anxiety, or nervousness
Knowing the signs of traumatic hemothorax will help you offer timely treatment to a patient with this condition.
Traumatic Hemothorax Treatment With Pigtail Catheters vs Large-Bore Chest Tubes
In a 2021 multicenter randomized clinical trial (RCT) by Narong Kulvatunyou et al, the researchers studied the effectiveness of pigtail catheters and open chest tubes in treating traumatic hemothorax.
The study was based on a previous single-center RCT done in 2018 by the same research team. It was conducted on 43 patients with traumatic hemothorax and hemopneumothorax at a level-1 trauma center.
It showed that 14F pigtail catheters had the same effects as 32F to 40F chest tubes when it came to chest drainage output for these two medical conditions.
In the latest study, the researchers assessed the efficacy of small (14F) pigtail catheters and large (28F to 32F) chest tubes for the treatment of traumatic hemothorax in 119 patients. They found that pigtail catheters are an effective and safe chest drainage method for traumatic hemothorax compared to large-bore chest tubes.
In addition, pigtail catheters are not only as effective as chest tubes but also cause less pain. This resulted in better and more comfortable patient outcomes.
Kulvatunyou, the study’s lead author and an associate professor of surgery at the University of Arizona College of Medicine–Tucson, said:
“I think there’s a misconception among many surgeons that you have to put in a big tube to drain blood, which is physically, scientifically not true. In terms of effectiveness, a big tube doesn’t add a whole lot, but causes more pain for patients.”
The new RCT counters the established maxim in the medical world that requires large-bore chest tubes for effective drainage of blood or air from the thoracic cavity.
Moreover, pigtail catheter placement has a shorter learning curve than chest tubes as the procedure is much easier. This enables faster medical treatment while ensuring less pain and discomfort for patients.
Methods of the Study
In the RCT, the researchers compared 14F pigtail catheters with 28F to 32F chest tubes in the treatment of patients who had traumatic hemothorax. They conducted the study for over five years from July 2015 to September 2020. The primary result indicated a high failure rate which meant that persistent traumatic hemothorax needed another intervention.
The secondary outcomes included:
- Hospital and intensive care unit admittance
- Daily drainage output
- Tube days
- Insertion perception experience (IPE) score ranging from 1 to 5, where 1 meant a tolerable experience and 5, the worst experience
Let’s delve into the results and conclusion of the RCT below.
Results and Conclusion of the Study
The two groups of patients with pigtail catheters and chest tubes had similar baseline characteristics, failure rates, and secondary outcomes.
However, patients with pigtail catheters had lower IPE scores with a median of 1 and an interquartile range of 1 to 2. Meanwhile, patients with chest tubes reported a median score of 3 and an interquartile range of 2 to 5.
The researchers concluded that small-caliber pigtail catheters can effectively drain traumatic hemothorax as efficiently as large chest tubes. Pigtail catheters also led to better IPE scores than chest tubes which suggests that patients can tolerate pigtail catheters better.
Stay Up-to-date With the Latest Medical Courses
If you work with patients suffering from traumatic hemothorax and have been using chest tubes for drainage, it’s time to update your skills and knowledge.
Hospital Procedures Consultants offers high-value courses like the Pigtail Catheter Placement Course: Chest Tube Course and the Wayne Pneumothorax Evacuation Course: Pigtail Catheter Placement Course, among others. These courses will teach you everything you need to know about pigtail catheter placement and other key skills.
As a participant, you can get hands-on learning and the necessary certifications that will equip you to become an expert in your healthcare field.
Kulvatunyoum, N. Bauman, Z. Edine, S. Moya, M. The small (14 Fr) percutaneous catheter (P-CAT) versus large (28-32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial. J Trauma Acute Care Surg. 2021. 1(91) 809-813
Gomez, L. Tran, V. Hemothorax.. Book – Continuing Education Activity
Bauman, Z. Kulvatunyou, N. Joseph, B. Jain, A. Friese, R. Gries, L. O´Keeffe, T. Tang, A. Vercruysse, G. Rhee, P. A Prospective Study of 7-Year Experience Using Percutaneous 14-French Pigtail Catheters for Traumatic Hemothorax/ Hemopneumothorax at a Level-1 Trauma Center: Size Still Does Not Matter. World J Surg. 2018. 42(1): 107- 113