What are the best methods for prolonged pleural space drainage?
Pose this question to any emergency healthcare provider, and they’ll say it’s tube thoracostomy. It can be a lifesaver when it comes to removing fluid and air from the pleural space, preventing them from returning, and restoring negative pressure while re-expanding the lung.
However, the procedure isn’t without risks. From insertion to removal, it brings a range of complications, such as:
- Tube malposition which is more prevalent in critically ill patients. Wrong insertion was detected in 30% of percutaneously inserted chest tubes.
- A blocked drain can lead to complications like unresolved or undrained pleural fluid and air leaks. This can even damage lung tissue.
- Reexpansion Pulmonary Edema (REPE), a condition with a mortality rate of up to 20%.
It can also cause nerve injuries, subcutaneous emphysema, vascular and cardiac injuries, as well as esophageal perforation, among others. If the tube isn’t removed properly, it can make the patient’s hospital stay longer, requiring patients to undergo another invasive procedure, and increasing the incidence of a spontaneous pneumothorax which requires the reinsertion of a chest tube.
Fortunately, there is a way to mitigate most of these complications: the pigtail catheter for pleural drainage. Learn more about it with Hospital Procedures Consultants.
What Is a Pigtail Catheter? Why Is It Used?
A pigtail catheter (PC) is a small, flexible chest tube that is commonly available in various sizes such as 6, 8, 8.5, 10, 12, 14, 16, and 18 Fr. It is a less invasive alternative for pleural drainage as seen in a study of 109 consecutive 8.3 French pigtail catheter placements.
Several studies and clinical trials back this.
In a 2021 clinical trial, for example, small caliber 14 Fr pigtail catheters were found to be as effective at draining traumatic hemothorax. They were also better tolerated by patients.
In comparison, thoracic trauma comprises a quarter of traumatic deaths in the US. Hence, the decision to use pigtail catheter placement versus chest tube placement could be a matter of life and death. This is particularly true given the fact that large-bore chest tubes have been associated with more cases requiring reinsertion.
And yet, many clinicians still believe that larger chest tubes are more effective than pigtail catheters for pleural drainage. While there may be some truth to this, a recent study established that pigtail catheters initially extracted more fluid and air than large-bore chest tubes—the mean difference was 114.7 mL.
The study also showed a reduced risk of video-assisted thoracoscopic surgery (VATS) and shorter chest tube duration. As such, it can be a safe, less invasive, and more reliable alternative to traditional chest tubes. Given these findings, clinicians should consider the utilization of pigtail catheters to improve trauma patient outcomes in relatively stable patients with a traumatic hemothorax or a traumatic pneumothorax.
In addition to regular pigtail catheters, patients can also benefit from the double-pigtail catheter (DPC). The DPC is distinguishable by an additional coiled pigtail towards the middle of its shaft. It has a lower dysfunctional retraction rate and has been shown to have higher clinical success rates than single pigtail catheters. It also exhibits a shorter indwelling time, which can shorten hospital stays.
In Which Cases Should Pigtail Catheters Be Used?
While a pigtail catheter is an incredibly effective tool, it has its limitations. It works best in cases where non-clotted, non-viscous fluids must be drained.
As such, it can be used in the following cases:
14 Fr percutaneous pigtail catheters have been found to be just as effective as 28 to 32 Fr chest tubes in the traditional management of stable patients with a traumatic hemothorax, with no significant difference in failure rates.
The ultrasound-guided insertion of a pigtail catheter is safe and effective for draining fluid from the pleural cavity and must be prioritized as the primary intervention.
PCs may also be used for complicated parapneumonic effusions and empyema with a high catheter insertion success rate of 72.2%. However, it may not be suitable for loculated empyemas and other loculated pleural effusions that yield low success rates.
Iodized talc slurry can be injected through a small-bore pigtail catheter for treating malignant pleural effusion. It is a safe treatment method. Its most frequently recorded adverse effect is pleuritic chest pain which is easily treated with nonsteroidal anti-inflammatory drugs.
In managing patients with spontaneous pneumothorax, the success rate was higher among patients with pigtail catheters. They also benefited from shorter procedures with milder pain during insertion and removal. Additionally, patients exhibited lower analgesic drug use and had shorter hospital stays.
A pigtail catheter can also be used as an initial treatment for those with secondary pneumothorax associated with obstructive lung conditions and malignancy.
Learn More About Pigtail Catheters With Hospital Procedures Consultants
The pigtail catheter for pleural drainage has a significant advantage over large-diameter chest tubes and they’re well-suited for certain conditions.
So, if you work with patients with pneumothoraces, grow your skills in both tube thoracostomy and pigtail catheter placement.
Hospital Procedures Consultants’ Pigtail Catheter Placement Course will teach you traditional wire-directed pigtail catheter placement along the mid-clavicular line. You can also enroll in our Tube Thoracostomy Course which will familiarize you with correct tube placement, including how to place a pigtail catheter that can be attached to a Heimlich valve or a Pleur-Evac container.
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