The pigtail catheter for pleural drainage: a less invasive alternative to tube thoracostomy

Abstract

Background: Tube thoracostomy remains the standard of care for the treatment of pneumothoraces and simple effusions. This report describes a favorable experience with the 8.3 French pigtail catheter as a less invasive alternative to traditional chest tube insertion.

Methods: We retrospectively reviewed 109 consecutive pigtail catheter placements. Catheters were inserted under local anesthesia at the bedside without radiographic guidance. Pre- and post-insertion chest radiographs were reviewed to determine efficacy of drainage.

Results: Fifty-one of 109 patients (47%) were mechanically ventilated and 26 patients (24%) had a coagulopathy. 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 2899 ml over 97 hours. Mean pneumothorax size diminished from 38 to 1 percent during an average 71-hour placement. Clinical success rates in the effusion and pneumothorax groups were 86 and 81 percent, respectively.

Conclusion: The pigtail catheter offers reliable treatment of pneumothoraces and simple effusions and is a safe and less invasive alternative to tube thoracostomy.

Figure 1.

The 8.3 French pigtail catheter (Cook Inc., Bloomington, IN; C-PCS-830-LOCK). The catheter is constructed of polyethylene and has six sideholes at the distal end.

Figure 2.

Relative sizes of the average intercostal distance in the adult (fifth intercostal space, mid-axillary line), two commonly used chest tube sizes (24 F and 32 F), and the 8.3 F pigtail catheter.