All consecutive patients with pleural effusion requiring drainage were subjected to either tube thoracostomy or pig tail drainage. A standardized questionnaire was prepared for retrieving data. Outcomes of interest were time to drain and total duration of hospital stay. Thirty-five patients were treated with traditional chest tubes, whereas 57 patients were treated with pigtail catheters. There were no significant differences in either drainage days or hospitalization days between the chest tube group and pigtail catheter group 9.
Conclusions: The pigtail catheter offers reliable treatment of effusions and is a safe and less invasive alternative to tube thoracostomy. There was no significant difference in time to drain and duration of hospital stay in both the groups. J Curr Surg. User Username Password Remember me. Nine cases had procedure failure, five due to loculated effusions, and four due to rapid reaccumulation of fluid after catheter removal.
Only two empyema cases out of six had a successful procedure. Pigtail catheter insertion is an effective and safe method of draining pleural fluid. We encourage its use for all cases of pleural effusion requiring chest drain except for empyema and other loculated effusions that yielded low success rate.
Pleura is divided into a parietal layer which lines the inner aspect of the chest wall and a visceral layer which covers the lung and lines the interlobar fissures [ 1 ].
Pleural effusion is the abnormal accumulation of fluid in the pleural space. A pleural effusion is always abnormal and indicates the presence of an underlying disease. Approximately 1. Normal liquid and protein enter pleura space from the systemic circulation and are removed by the parietal pleural lymphatics. Because the mesothelial boundaries are leaky, excess liquid can move across into the lower pressure intrapleural , high-capacitance space and collect as a pleural effusion.
These effusions can form based on disease of the pleural membranes themselves or disease of thoracic or abdominal organs [ 3 ]. Fluid collection within the pleural cavity can be assessed with clinical and radiological means.
When pleural effusion is detected, the characteristics of the fluid exudate or transudate must be revealed using thoracocentesis [ 1 ]. Tube thoracostomy remains the standard of care for the treatment of pneumothorax and simple effusions in most hospitals [ 4 ]. Placement of a large-bore chest tube is an invasive procedure with potential morbidity and complications and therefore the use of small-bore pigtail catheter may be desirable [ 5 ].
The aim of this study was to evaluate the efficacy and complications of using pigtail catheter in drainage of pleural effusion as a less invasive alternative to traditional chest tube insertion. The current work is a prospective noncontrolled study for revision of inpatient pigtail catheter insertions performed between January and May at the international hospital of Bahrain, a tertiary care hospital, Kingdom of Bahrain. All adult patients with pleural effusions who were planned to have chest tube insertion were included.
Informed signed consent was obtained from all patients eligible to participate in the study. The local ethical committee approved the study protocol.
Detailed history taking and complete medical examination were done to all patients. Coagulation profile was done to all patients. Chest radiographs were done before and after the procedure to determine efficacy of drainage Figure 1. The site of catheter insertion was determined according to ultrasound findings. In most cases, the site of insertion was in the 5th or the 6th intercostals space in the mid-axillary line.
Needles were inserted just above the top of the rib to avoid injury of the intercostal bundle. Insertion of pigtail catheters was done using the modified Seldinger technique [ 6 ] and in accordance with the British Thoracic Society guideline for insertion of chest drain [ 7 ].
In brief, few cubic centimeters of pleural fluid were withdrawn with the needle to confirm that the distal end of the needle is inside the pleural cavity, and passage of the guide wire into the pleural space became effortless.
Development of an adequate tract with the dilator and insertion of the pigtail catheter so that the side holes are well within the pleural cavity are important for proper function. The therapy was considered successful if the opacity cleared on chest radiograph and confirmed on ultrasonography of the thorax and also if there was no need for a second intervention repeat pigtail placement, tube thoracostomy, or operation within 72 hours after removal of the pigtail catheter.
Patients were given, beside pigtail catheter insertion, the standard therapy according to the cause of pleural effusion. For malignant pleural effusion, pleurodesis was done using bleomycin 0. For tuberculous pleural effusion, standard antituberculous chemotherapy and corticosteroids were given.
For parapneumonic effusions, antibiotics were given according to the American thoracic society recommendations [ 8 ]. For cases of heart failure, antifailure treatment and diuretics were given. For hypoproteinemia cases, albumin infusion and diuretics were given. The end point of the study was either the resolution of the effusion and a decision to remove the catheter or the need for another intervention.
The current study reviews our experience with 51 cases having pigtail catheters inserted for treatment of pleural effusion over a sixteen-month period. Eleven patients had malignant pleural effusion five cases secondary to nonsmall cell lung cancer, two cases secondary to breast cancer, two cases secondary to gastrointestinal cancer, and two cases with malignant mesothelioma.
Six patients had tuberculous pleural effusion. Twenty patients had parapneumonic effusion: six of them had empyema. Fourteen cases had transudative pleural effusion; eight secondary to heart failure and six secondary to hypoproteinemia. Age and sex of the patients are shown in Table 1. The duration of drainage of pleural fluid using pigtail catheter ranged between three and 14 days with a mean of 5.
The amount of pleural fluid drained was 2 3 8 9. Complications of pigtail catheter included pain at the insertion site requiring analgesia in 23 patients, pneumothorax in ten patients, blockage of the catheter in two patients, and infection in one patient Table 1.
Pneumothoraces were resolved spontaneously through the same catheter. Blockage of the catheters and infection were associated with procedure failure.
Pigtail catheter drainage of pleural effusion was successful in 42 out of 51 patients with a success rate of The success rate was highest with transudative pleural effusion 12 out of 14, Among the six cases of empyema, the procedure was successful only in two of them success rate Among the nine cases of failure, five of them were due to loculated effusions four with empyema and one with tuberculous effusion , and four of them were due to rapid re-accumulation of the fluid after removal of the catheter one case of heart failure, one case of hypoproteinemia, and two cases of malignant effusion with failure of pleurodesis.
In both parapneumonic and tuberculous pleural effusion groups, all failures were associated with presence of loculation Table 2.
If the cases of loculated pleural effusions are excluded, the success rate increases to The recent interest in the use of small-bore catheters for pleural effusion drainage is based on the idea that it may be less invasive procedure and thus better tolerated by patients compared to standard large-bore chest tubes, with no compromise in efficacy. In our study, the mean duration of pleural fluid drainage using pigtail catheter was 5.
In other studies, the durations of drainage of pleural fluid using a pigtail catheter were more or less similar to our results. She has normal vitals and is complaining of left rib pain and shortness of breath. On your extended fast exam you detect no lung sliding on the left, and your suspicion of traumatic pneumothorax is confirmed by chest X-ray.
Though you are expert at conventional tube thoracostomy you wonder if there are other, perhaps less painful or traumatic methods for relieving the pneumothoraces of these two stable patients.
Traditionally, patients with pneumothoraces seen in the ED receive tube thoracostomy. However, in recent years, guidelines and statements from American College of Chest Physicians ACCP and British Thoracic Society BTS stress the value of observation, repeat imaging and prompt follow-up for stable, asymptomatic patients with no underlying lung disease or trauma.
An ACCP consensus statement further clarified observation for hours in an asymptomatic patient with less than 3 cm PTX without progression on subsequent expansion on CXR may be safely discharged with prompt follow-up and repeat radiography within 48 hours. In patients who do not qualify for conservative therapy, alternative therapies are simple aspiration in select candidates stable patients with primary spontaneous pneumothorax , and increasingly, small-bore chest tubes with Heimlich valves for a wider variety of patients.
Small-bore chest tubes — also referred to as pigtail catheters — are being used to relieve both spontaneous and in some cases, traumatic pneumothorax. These pigtails are placed with a Seldinger catheter-over-wire technique very similar to the central venous catheter insertion. Advantages of the percutaneous placement of small bore chest tubes are: less pain, no need for tissue dissection, less scarring and no need for suturing upon chest tube removal.
The technique decreases the risk of complications and shortens or eliminates hospital admission. Left: For PTX, optimal placement is in the safety triangle, bordered by the lateral edge of the pectoral muscle, the lateral edge of the latisimus dorsi and a line along the fifth intercostal space at the level of the nipple.
Right: Anesthetize the skin and deeper tissues with increasingly larger needles inserted over the superior aspect of the rib to minimize damage to the neurovascular bundle which travels along the inferior aspect of the rib. Chest tubes have traditionally been placed to evacuate pneumothoraces, hemothoraces, and pleural effusions as well as provide pleurodesis.
While rapid tube thoracostomy is still preferred in an unstable patient, pigtail catheters with Heimlich valves are increasingly preferred to large bore chest tubes in the treatment of pneumothoraces and simple pleural effusions due to their less traumatic less painful insertion and lower cost.
They also offer decreased risk of hemorrhage in anticoagulated patients or those with bleeding diathesis. There were no complications related to pigtail catheter insertion. Seventy-seven pigtail catheters were placed for pleural effusion and 32 for pneumothorax. Mean effusion volume decreased from 43 to 9 percent, and drainage averaged ml over 97 hours.
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