Small-bore catheter is more than an alternative to the ordinary chest tube for pleural drainage

Ultrasound-guided small-bore chest drain placement: a retrospective analysis of feasibility, safety and clinical implications in internal medicine ward

PURPOSE

Massive and complex pleural effusions represent a frequent challenge for internists, particularly when patients present with significant symptoms and the hospital setting lacks dedicated thoracic surgery or interventional pneumology services.

METHODS

This retrospective study evaluates the effectiveness and feasibility of ultrasound-guided small-bore chest drain placement performed by internal medicine physicians with interventional ultrasound experience. We analyze procedural success rates, complication profiles, and subsequent clinical management in a cohort of patients managed in a single internal medicine ultrasound ward.

RESULTS

In our series of ten patients, ultrasound-guided drain placement was successful in all cases. No immediate major complications were encountered, and subsequent complications were minimal and manageable.

CONCLUSION

Ultrasound-guided small-bore chest drain placement is a feasible, safe, and effective alternative to surgical chest tube insertion in selected patients in internal medicine wards, potentially avoiding the need for hospitalization or transfer to specialized thoracic surgery services.

Reintervention Rate After Pigtail Catheter Insertion Compared to Surgical Chest Tubes

BACKGROUND

Prior studies suggest similar efficacy between large-bore chest tube (CT) placement and small-bore pigtail catheter (PC) placement for the treatment of pleural space processes. This study examined reintervention rates of CT and PC in patients with pneumothorax, hemothorax, and pleural effusion.

METHODS

This retrospective study examined patients from September 2015 through December 2020. Patients were identified using ICD codes for pneumothorax, hemothorax, or pleural effusion. Use of a pigtail catheter (≤14Fr) or surgical chest tube (≥20Fr) was noted. The primary outcome was overall reintervention rate within 30 days of tube insertion. Patients who died with a pleural drainage catheter in place, unrelated to complications from chest tube placement, were excluded.

RESULTS

There were 1032 total patients in the study: 706 CT patients and 326 PC patients. The PC group was older with more comorbidities and more likely to have effusion as the indication for pleural drainage. Patients with PC were 2.35 times more likely to have the tube replaced or repositioned (P < .0001), 1.77 times more likely to require any reintervention (P = .001) and 2.09 times more likely to remain in the hospital >14 days (P < .0001) compared to patients with CT.

CONCLUSION

PCs have a significantly higher reintervention rate compared to CT for the treatment of pneumothorax, hemothorax, and pleural effusion. Although PC are believed to cause less pain and tissue trauma, they do not necessarily drain the pleural space as well as CT. Decisions on which method of draining the chest should be made on a case-by-case basis.

The Frequency, Risk Factors and Management of Complications from Pleural Procedures

Pleural disease is a common presentation and spans a heterogenous population across broad disease entities but a common feature is the requirement for interventional procedures. Despite the frequency of such procedures, there is little consensus on rates of complications and risk factors associated with such complications. Here follows a narrative review based on a structured search of the literature. Searches were limited to 2010 onwards, in recognition of the sea-change in procedural complications following the mainstream use of thoracic ultrasound (US). Procedures of interest were limited to thoracocentesis, intercostal drains (ICD), indwelling pleural catheters (IPC) and local anaesthetic thoracoscopy (LAT). 4308 studies were screened, to identify 48 studies for inclusion. Iatrogenic pneumothorax (PTX) remains the commonest complication following thoracocentesis: 3.3% (95% CI, 3.2-3.4), though PTX requiring intervention was rare: 0.3% (95% CI, 0.2-0.4) when the procedure was US guided. Drain blockage and displacement are the commonest complications following ICD insertion (6.3%, and 6.8%, respectively). IPC related infections can be a significant problem: 5.8% (95% CI, 5.1-6.7), however most cases can be managed without removal of the IPC. LAT has an overall mortality of 0.1% (95% CI, 0.03-0.3). Data on safety and complication rates in procedural interventions are limited by methodological problems and novel methods to study this topic bears consideration. Whilst complications remain rare events, once encountered, they have the potential to rapidly escalate. It is of paramount importance for operators to prepare and have in place plans for such events, to ensure high quality and above all, safe care.

The Application of Pigtail Catheters in Postoperative Drainage of Lung Cancer

BACKGROUND

Although minimally invasive surgery has been widely carried out at present, the postoperative pain of patients with lung cancer is still one of the difficult problems to solve in clinical practice.

OBJECTIVE

This study explored whether indwelling pigtail catheters after lung cancer surgery can help to reduce postoperative pain and promote the recovery of patients as soon as possible.

MATERIALS AND METHODS

From June 2018 to June 2020, patients who underwent thoracoscopic radical resection of lung cancer in our hospital were randomly divided into 2 groups: the pigtail catheter group and the control group. We compared the postoperative time of thoracic catheter removal, postoperative pain score, proportion of postoperative pleural effusion, postoperative hospitalization time, and postoperative complications of the 2 groups.

RESULTS

A total of 1375 patients were enrolled, including 677 patients in the pigtail catheter group and 698 patients in the control group. Compared with the control group, the pigtail catheter group had an earlier time of thoracic catheter removal, lower postoperative pain score, lower proportion of pleural effusion diagnosed by postoperative chest radiograph, and shorter postoperative average hospital stay, but there was no significant difference in postoperative complications.

CONCLUSION

The application of pigtail catheters after radical resection of lung cancer can reduce postoperative pain, accelerate the recovery of patients and shorten the postoperative hospital stay and is safe and reliable in clinical application.