Transitioning from Stiff Chest Tubes to Soft Pleural Catheters: Prospective Assessment of a Practice Change

 

 Buy Article Permissions and Reprints

Abstract

Background Tube thoracostomies in children are required for multiple indications and can be associated with significant discomfort. In 2010, a multidisciplinary team at our institution developed a protocol to replace stiff chest tubes with 8.5-French soft pleural catheters in children requiring pleural drainage.

Methods Before initiating the protocol, an audit sheet was developed to prospectively capture data regarding insertion, removal, complications, and success. After 8 months of new protocol utilization, these data were reviewed, along with a retrospective review of the patients' charts.

Results Twenty-three patients had 33 pleural catheters inserted over an 8-month period. Mean age was 6.7 years (1 day to 17 years). Indications for insertion were pneumothorax (24%), simple effusion (24%), chylothorax (27%), parapneumonic effusion/empyema (21%), and malignant effusion (3%). Complications included premature dislodgment (33%), blockage (15%), pneumothorax (3%), and bleeding (3%). Mean duration of pleural drainage was 7.27 days (0 to 37 days). Pleural drainage was successful in 91% of patients.

Conclusion Soft pleural catheters are an acceptable alternative to traditional stiff chest tubes in the pediatric population. Premature dislodgment was the most common problem. Prospective audits are extremely valuable in assessing new procedural protocols and practice changes.

Note

This article was presented at the 43rd annual meeting of the Canadian Association of Pediatric Surgeons, Ottawa, Ontario, Canada, September 22 to 24, 2011.

• References

• 1 Fysh ET, Smith NA, Lee YC. Optimal chest drain size: the rise of the small-bore pleural catheter. Semin Respir Crit Care Med 2010; 31 (6) 760-768
  Article in Thieme ConnectPubMedGoogle Scholar
• 2 MacDuff A, Arnold A, Harvey J. BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax: British thoracic society pleural disease guideline 2010. Thorax 2010; 65 (Suppl. 02) ii18-ii31
  CrossrefPubMedGoogle Scholar
• 3 Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ. BTS Pleural Disease Guideline Group. Management of a malignant pleural effusion: British thoracic society pleural disease guideline 2010. Thorax 2010; 65 (Suppl. 02) ii32-ii40
  CrossrefPubMedGoogle Scholar
• 4 Horsley A, Jones L, White J, Henry M. Efficacy and complications of small-bore, wire-guided chest drains. Chest 2006; 130 (6) 1857-1863
  CrossrefPubMedGoogle Scholar
• 5 Davies HE, Merchant S, McGown A. A study of the complications of small bore ‘Seldinger’ intercostal chest drains. Respirology 2008; 13 (4) 603-607
  CrossrefPubMedGoogle Scholar
• 6 Benton IJ, Benfield GF. Comparison of a large and small-calibre tube drain for managing spontaneous pneumothoraces. Respir Med 2009; 103 (10) 1436-1440
  CrossrefPubMedGoogle Scholar
• 7 Roberts JS, Bratton SL, Brogan TV. Efficacy and complications of percutaneous pigtail catheters for thoracostomy in pediatric patients. Chest 1998; 114 (4) 1116-1121
  CrossrefPubMedGoogle Scholar
• 8 Park JK, Kraus FC, Haaga JR. Fluid flow during percutaneous drainage procedures: an in vitro study of the effects of fluid viscosity, catheter size, and adjunctive urokinase. AJR Am J Roentgenol 1993; 160 (1) 165-169
  CrossrefPubMedGoogle Scholar
• 9 St Peter SD, Tsao K, Spilde TL , et al. Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial. J Pediatr Surg 2009; 44 (1) 106-111 , discussion 111
  CrossrefPubMedGoogle Scholar
• 10 Sonnappa S, Cohen G, Owens CM , et al. Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema. Am J Respir Crit Care Med 2006; 174 (2) 221-227
  CrossrefPubMedGoogle Scholar
• 11 Liu Y-H, Lin Y-C, Liang SJ , et al. Ultrasound-guided pigtail catheters for drainage of various pleural diseases. Am J Emerg Med 2010; 28 (8) 915-921
  CrossrefPubMedGoogle Scholar
• 12 Chibuk TK, Cohen E, Robinson JL, Mahant S, Hartfield D. Paediatric complicated pneumonia: Diagnosis and management of empyema. Paediatr Child Health (Oxford) 2011; 16 (7) 425-429
  PubMedGoogle Scholar