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Review
. 2016 Jul;8(7):E503-10.
doi: 10.21037/jtd.2016.06.25.

When size matters: changing opinion in the management of pleural space-the rise of small-bore pleural catheters

Pier Luigi Filosso  1 , Alberto Sandri  1 , Francesco Guerrera  1 , Andrea Ferraris  2 , Filippo Marchisio  2 , Giulia Bora  1 , Lorena Costardi  1 , Paolo Solidoro  3 , Enrico Ruffini  1 , Alberto Oliaro  1
Affiliations
Review

When size matters: changing opinion in the management of pleural space-the rise of small-bore pleural catheters

Pier Luigi Filosso et al. J Thorac Dis. 2016 Jul.

Abstract

Tube thoracostomy is usually the first step to treat several thoracic/pleural conditions such as pneumothorax, pleural effusions, haemothorax, haemo-pneumothorax and empyema. Today, a wide range of drains is available, ranging from small to large bore ones. Indications for an appropriate selection remains yet matter of debate, especially regarding the use of small bore catheters. Through this paper, we aimed to retrace the improvements of drains through the years and to review the current clinical indications for chest drain placement in pleural/thoracic diseases, comparing the effectiveness of small-bore drains vs. large-bore ones.

Keywords: Air leak; chest drain; digital chest drain system; postoperative management; traditional chest drain system.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Large-bore chest drain insertion modalities. (A) The trocar technique; (B) blunt dissection.
Figure 2
Figure 2
Small-bore drain possible complications. (A) Kinking with fluid blockage; (B) drain rupture.
Figure 3
Figure 3
Small-bore drain complications. (A) Chest X-ray and (B) thoracic CT scan showing a Pleurocath intraparenchimal insertion (red arrow); (C,D) Pleurocath escape from the point of insertion in the chest wall.
Figure 4
Figure 4
Small-bore chest drains. (A,B) 20-F Argyle, 8-F Pleurocath and 12-F Unico; (C,D) comparison of 8-F Pleurocath and 12-F Unico devices: the smooth and less traumatic Unico’s tip is evident.
Figure 5
Figure 5
Localized empyema successfully drained with a small-bore tube under CT guidance.
Figure 6
Figure 6
Drainage choice is usually made according to the habitus of the patient. (A,B) 20-F Argyle drain in a severe obese for hemo-pneumothorax; (C) 12-F Unico placed in an anorexic woman for inflammatory pleural effusion.
Figure 7
Figure 7
Posterior Unico placement in a patient with malignant pleural effusions after a right upper lobectomy for lung cancer.
Figure 8
Figure 8
Ventilated severe COPD patient with right-sided pneumothorax (red arrows) in which an Unico was placed to drain the chest.
See this image and copyright information in PMC

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