The double lumen set has an additional lumen available for aspiration or infusion. Pigtail catheter was blocked with failure of the drainage. These effusions can form based on disease of the pleural membranes themselves or disease of thoracic or abdominal organs [3]. Among initial failures in the pneumothorax group, one was associated with malposition of the catheter four days after placement (and initial resolution of the pneumothorax). Walsh et al. The clear polyvinylchloride catheter with a radiopaque stripe allows fluid to be seen during the drainage procedure. View more details about the Peritoneal Lavage Set and Tray. By clicking Submit, you agree to the terms and conditions for collecting and processing your personal information, as included in our customer data privacy notice. Saffran et al. The average intercostal space in an adult (measured at the 5th intercostal space in the mix-axillary line) is 8.8 1.4 millimeters. In a retrospective study, Parulekar et al. treated small, asymptomatic, iatrogenic pneumothoraces with a 9 F catheter inserted in the second intercostal space under fluoroscopic guidance with a success rate of 87%.7 A recent extensive review of techniques of thoracic drainage mentions small-bore catheters only in the context of the treatment of spontaneous or post-needle biopsy pneumothoraces in neonates.1 A similar review does not include the small-bore catheter as a therapeutic option.8. 
Catheterization and angiography device panel. One should have a low threshold for additional radiographie study of a pleural fluid collection that does not respond to initial drainage maneuvers. The new PMC design is here! View more details about the Lock Pericardiocentesis Set and Tray. 67-year-old male with transudative effusion due to hypoproteinemia caused by chronic liver disease. Seldinger placement facilitates controlled, minimally invasive catheter introduction.
We retrospectively reviewed 109 consecutive pigtail catheter placements. sharing sensitive information, make sure youre on a federal Saffran et al. No related content is available yet for this article. Walsh et al. Used for connection to other medical devices such as catheters. A 24 F chest tube (the smallest size commonly used for the described indications) has an outer diameter of 8 mm, while a 32 F chest tube has an outer diameter of just under 11 mm. [11] found a mean duration of drainage of 97 hours. The 40 cm long catheter is designed to cater to larger patient anatomies. 41-year-old female with transudative effusion due to heart failure. Patz et al. In the present study, pigtail catheter drainage of pleural effusion was successful in 82.35% of cases. In another study, Liang et al. Treatment details are outlined in Table 1.
The site of catheter insertion was determined according to ultrasound findings. The pneumothorax group included: central line-related (10), trauma (9), spontaneous (7), and postoperative (6). We offer an extensive line of chest tubes for removing both air and fluid from the pleural and pericardial spaces. Prospectively, we evaluated efficacy and safety of pigtail catheter (8.514 French) insertion in 51 cases of pleural effusion of various etiologies. Sign Up. about navigating our updated article layout. [13] published a series of 19 patients with malignant effusions who underwent ambulatory pleurodesis (with bleomycin) using small-bore (10.3F) catheter drainage. View more details about the Fuhrman Pleural/PneumopericardialDrainage Setand Tray. View each products indications for use, specifications, components, and other resources by clicking the links below. The set comes with the Cook Chest Drain Valve, which is designed to help remove air from the pleural cavity. Different catheters have different combinations of stiffness, diameter, angle and shape. Tube thoracostomy remains the standard of care for the treatment of pneumothorax and simple effusions in most hospitals [4].
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. Resolution occurred in 22 patients. Fifty-one of 109 patients (47%) were mechanically ventilated and 26 patients (24%) had a coagulopathy. official website and that any information you provide is encrypted Pigtail catheter are named for the tight coil at the end of the catheter that resembles a pig's tail. Pigtail catheters have been shown to have a comparable efficacy to chest tubes in patients with pneumothorax.*. Pigtail catheter was blocked with failure of the drainage. When pleural effusion is detected, the characteristics of the fluid (exudate or transudate) must be revealed using thoracocentesis [1]. There are six side holes at the distal end of the catheter. Review of failures in both groups (Table 2) suggests that refinement of patient selection and management strategies would yield even higher success rates for the treatment of both pneumothoraces and effusions. 2011;71(5):11041107. Salient technical aspects of pigtail catheter insertion include appropriate use of local anesthetic and needle insertion that barely walks over the top of the rib to avoid the intercostal bundle. In our study, the mean duration of pleural fluid drainage using pigtail catheter was 5.8 days (314 days). Used for the evacuation of air from the pericardial sac orthe drainage of air or fluid from the pleural space. 2012, Article ID 143295, 6 pages, 2012. https://doi.org/10.5402/2012/143295, 1Chest Department, Faculty of Medicine, Tanta University, Tanta 33633, Egypt, 2Internal Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt. Patz et al. Chest tubes, with their excessive size, cause pain by compressing the neurovascular bundle at the top of the interspace, as well as by levering open the interspace. We found that exclusion of patients with preplacement evidence of loculated effusions would have yielded a success rate of 91.3% for effusions treated by pigtail catheter drainage. *Kulvatunyou N, Vijayasekaran A, Hansen A, et al. View more details about the Catheter Aspiration Set for Simple Pneumothorax. Overall success rate was 82.35% (85.71% for transudative, 83.33% for tuberculous, 81.81% for malignant, and 80% for parapneumonic effusion). The pigtail catheter is attached to a standard thoracic drainage system and suction applied for pneumothoraces. mL (Table 1). [16] found that the complication rate was low and consisted of symptoms such as pain and fever with using small tube drainage and doxycycline sclerotherapy. Gammie et al. Exclusion of the two patients (three catheter placements) with severe underlying parenchymal disease and prevention of pigtail migration in the fourth would have yielded a success rate of 30/32, or 94% for pneumotho-races. The high clinical success rate combined with the absence of insertion-related complications strongly supports broader use of the pigtail catheter for drainage of simple effusions and pneumothoraces. For malignant pleural effusion, pleurodesis was done using bleomycin (0.75mg/kg was administered as a single dose. Address reprint request to: James D. Luketich, MD, Section of Thoracic Surgery and The Minimally Invasive Center, University of Pittsburgh Medical Center, 300 Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA. Get Email about News, Products, and Events from Cook Medical. Telephone: (412) 648-6736, Fax: (412) 648-6761, E-mail: This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License (, Pneumothorax, Pleural effusion, Catheter, Drainage, Determining the size of pneumothorax in the upright patient, Emergency treatment of pneumothorax: a simple catheter technique for use in the radiology department, New pigtail catheter for pleural drainage in pediatrie patients. Eight of 13 effusions were adequately treated using the small-bore catheter, compared with four of 11 effusions treated with the standard chest tube. In accordance with the results of our study, Sartori et al. Treatment details of patients undergoing insertion of pigtail catheters for pneumothorax or simple effusion. Fourteen cases had transudative pleural effusion; eight secondary to heart failure and six secondary to hypoproteinemia. I. Gotsman, Z. Fridlender, A. Meirovitz, D. Dratva, and M. Muszkat, The evaluation of pleural effusions in patients with heart failure,, M. L. Mayse, Non-malignant pleural effusions, in, V. C. Broaddus and R. W. Light, Pleural effusion, in, J. S. Roberts, S. L. Bratton, and T. V. Brogan, Efficacy and complications of percutaneous pigtail catheters for thoracostomy in pediatric patients,, S. I. Seldinger, Catheter replacement of the needle in percutaneous arteriography; a new technique,, D. Laws, E. Neville, and J. Duffy, BTS guidelines for the insertion of a chest drain,, L. A. Mandell, R. G. Wunderink, A. Anzueto et al., Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the management of community-acquired pneumonia in adults,, W. Parulekar, G. Di Primio, F. Matzinger, C. Dennie, and G. Bociek, Use of small-bore vs large-bore chest tubes for treatment of malignant pleural effusions,, Y. H. Liu, Y. C. Lin, S. J. Liang et al., Ultrasound-guided pigtail catheters for drainage of various pleural diseases,, J. S. Gammie, M. C. Banks, C. R. Fuhrman et al., The pigtail catheter for pleural drainage: a less invasive alternative to tube thoracostomy,, L. Saffran, D. E. Ost, A. M. Fein, and M. J. Schiff, Outpatient pleurodesis of malignant pleural effusions using a small-bore pigtail catheter,, E. F. Patz, H. P. McAdams, P. C. Goodman, S. Blackwell, and J. Crawford, Ambulatory sclerotherapy for malignant pleural effusions,, J. D. Luketich, M. Kiss, J. Hershey et al., Chest tube insertion: a prospective evaluation of pain management,, F. W. Walsh, W. M. Alberts, D. A. Solomon, and A. L. Goldman, Malignant pleural effusions: pleurodesis using a small-bore percutaneous catheter,, K. G. Seaton, E. F. Patz, and P. C. Goodman, Palliative treatment of malignant pleural effusions: value of small-bore catheter thoracostomy and doxycycline sclerotherapy,, Y. C. Chang, E. F. Patz, and P. C. Goodman, Pneumothorax after small-bore catheter placement for malignant pleural effusions,, M. C. Morrison, P. R. Mueller, M. J. Lee et al., Sclerotherapy of malignant pleural effusion through sonographically placed small-bore catheters,, W. H. Warren, R. Kalimi, L. M. Khodadadian, and A. W. Kim, Management of malignant pleural effusions using the pleurx catheter,, S. J. Liang, C. Y. Tu, H. J. Chen et al., Application of ultrasound-guided pigtail catheter for drainage of pleural effusions in the ICU,, C. J. Grodzin and R. A. The radiopaque catheter material enhances x-ray visualization. Careers, Division of Cardiothoracic Surgery University of Pittsburgh Medical Center Pittsburgh, PA. Duration of drainage of pleural fluid was 314 days. The sideports are positioned at the distal end of the chest tube. An official website of the United States government.
45-year-old male with tuberculous pleural effusion (loculated). In medicine, a catheter is a tube that can be inserted into a body cavity duct or vessel. We do not use the pigtail catheter on newly postoperative patients, trauma patients, or patients with suspected hemorrhagic effusions.
Balk, Indwelling small pleural catheter needle thoracentesis in the management of large pleural effusions,, C. L. Chung, C. H. Chen, C. Y. Yeh, J. R. Sheu, and S. C. Chang, Early effective drainage in the treatment of loculated tuberculous pleurisy,, Y. F. Lai, T. Y. Chao, Y. H. Wang, and A. S. Lin, Pigtail drainage in the treatment of tuberculous pleural effusions: a randomised study,, S. Sartori, D. Tassmari, P. Ceccotti et al., Prospective randomized trial of intrapleural bleomycin versus interferon alfa-2b via ultrasound-guided small-bore chest tube in the palliative treatment of malignant pleural effusions,, L. A. Parker, G. C. Charnock, and D. J. Delany, Small bore catheter drainage and sclerotherapy for malignant pleural effusions,. [10] reviewed 276 patients who underwent pigtail catheters (size from ten to 16 French) under ultrasound guidance for drainage of pleural effusions of various etiologies and pneumothoraces. Normal liquid and protein enter pleura space from the systemic circulation and are removed by the parietal pleural lymphatics. Mean pneumothorax size diminished from 38 to 1 percent during an average 71-hour placement. The enlarged sideports are designed to facilitate the drainage of air. 2011;71(5):11041107. Features and benefits Read the winning articles. The set comes with the Cook Chest Drain Valve, which is designed to help remove air from the pleural cavity. Success rates of using pigtail catheter in other studies were comparable to our findings. The radiopaque catheter material enhances x-ray visualization. days. [5] found that five percent of pigtail catheter placements were associated with serious complications (hemothorax, pnuemothorax, and hepatic perforation) and the overall complications of catheter use occurred in 20% of patients and included failure to drain, dislodgement, kinking, empyema, and disconnection. FOIA The https:// ensures that you are connecting to the Sargent reported using a 9 F catheter to treat pneumothoraces in 1970.3 Lawless and colleagues from the University of Pittsburgh used an 8.5 F pigtail catheter for the treatment of pneumothorax in 16 neonates and small children with a high success rate.4 Robinson applied Tenckhoff catheters for palliative drainage of malignant pleural effusion in nine patients.5 Martin reported the use of a small-bore 13 F catheter with an integral one-way valve for the treatment of simple pneumothoraces in 84 patients.6 All catheters were placed in the second intercostal space in the midclavicular line. Pigtail catheter drainage of pleural effusion was successful in 42 out of 51 patients with a success rate of 82.35%. Warren et al. Experience on the liver transplant service at our institution suggested that pneumothoraces and simple effusions could be successfully treated with the 8.3 F pigtail catheter. Features and benefits The 8.3 F pigtail catheter is now our method of choice for draining air and free-flowing simple effusions from the pleural space. HHS Vulnerability Disclosure, Help Centimeter markings on the pigtail catheter guide insertion. The radiopaque catheter material enhances x-ray visualization. Copyright Text is available under the Creative Commons Attribution/Share-Alike License.
Development of an adequate tract with the dilator and insertion of the pigtail so that the sideholes are well within the pleural cavity are important for proper function. The pigtail catheter may have utility for exudative (stage I, American Thoracic Society) empyemas, although our limited experience treating this entity with small-bore catheter drainage precludes a definitive conclusion; stage II (fibrinopurulent) and stage III (organized) empyemas require more invasive management. Fluid reaccumulated indicating failure of pleurodesis. 4 Used for emergency relief and temporary managementof suspected tension pneumothorax. The current study reviews our experience with 109 catheters inserted in 86 patients over a nine-month period. Nonlayering effusions should be drained with radiographie guidance. Used to infuse or withdraw rinsing solutions in theperitoneal cavity. One hundred and nine pigtail catheters were placed in 86 patients during the nine-month study period. The centimeter-marked dilators allow for additional control over the insertion of a chest tube into the pleural space. One patient had a wound infection and empyema that necessitated hospitalization for six days. Future studies are needed to compare pigtail catheter and other small bore drains with and without using Seldinger technique. There are a variety of coronary catheters available for different use cases. The current study reviews our experience with 51 cases having pigtail catheters inserted for treatment of pleural effusion over a sixteen-month period. No significant insertion complications, such as hollow organ perforation, were caused by this procedure. If the cases of loculated pleural effusions are excluded, the success rate increases to 91.3% (42 out of 46). [10] reported a mean duration of drainage of 6.1 days. [16] studied the use of small tube drainage and doxycycline sclerotherapy for malignant pleural effusion and reported a success rate of 81%. Among the six cases of empyema, the procedure was successful only in two of them (success rate 33.33%). Used in conjunction with a pneumothorax aspiration catheter if incomplete expansion of the lung persists after mechanical aspiration of air. For hypoproteinemia cases, albumin infusion and diuretics were given. Among the six cases of empyema, the procedure was successful only in two of them (success rate 33.33%). 8 The radiopaque catheter material enhances x-ray visualization. Parker et al. In practice, however, with free-flowing effusions and pneumothoraces (in which there is free communication throughout the pleural space), we have not found the site of placement of the pigtail catheter to have any bearing on procedural success. The pigtail catheter offers reliable treatment of pneumothoraces and simple effusions and is a safe and less invasive alternative to tube thoracostomy. No patients were mechanically ventilated. Pigtail catheter insertion is an effective and safe method of draining pleural fluid.
Before In another study, Morrison et al. The catheter material has radiopaque properties. Results. 2 67-year-old male with malignant pleural effusion. The enlarged sideports are designed to facilitate the drainage of air. Parulekar et al. View more details about the Thal-Quick Chest Tube Set and Tray. Used for the relief of simple, spontaneous, iatrogenic, and tension pneumothorax. You will be leaving the Cook Medical website that you were viewing and going to a Cook Medical website for another region or country. Conces et al. Adoption of this technique will provide the clinician with a valuable addition to his/her armamentarium that allows effective pleural drainage with minimal patient discomfort. Similarly, 81 percent of pigtails inserted for pneumothoraces were successful. [11] found that clinical success rates of pigtail catheter insertion for drainage of pleural effusion were 86% with no reported complications. Reaccumulation of the pleural effusion occurred in 3.8% of cases. The The local ethical committee approved the study protocol. The site is secure. In our hands, the pigtail catheter yielded rapid radiographie resolution of both pneumothoraces and pleural effusions. The Thal-Quick Chest Tube Adapter is sold separately. [13] reported a duration of catheter drainage of two to 11 days (mean 5.1 days). In other studies, the durations of drainage of pleural fluid using a pigtail catheter were more or less similar to our results. in [13] reported a success rate of 79% with the use of ambulatory pigtail catheter and pleurodesis for malignant effusions. [25] compared the efficacy of small-bore catheter drainage and pleurodesis to traditional drainage with standard chest tube in 24 malignant pleural effusions. Catheters were inserted under local anesthesia at the bedside without radiographie guidance. Copyright 2022 Regenstrief Institute, Inc. All Rights Reserved. Fluid re-accumulated indicating failure of pleurodesis. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. * 4 Seaton et al. This report describes a favorable experience with the 8.3 French pigtail catheter as a less invasive alternative to traditional chest tube insertion. Liu et al. [9] found that small-bore catheter 12 French was as effective as standard chest tube for drainage of malignant pleural effusion and pleurodesis without significant differences in the rate of complications. One patient experienced reexpansion pulmonary edema. 9 59-year-old male with empyema with loculations. These patients were quite ill: one-half were on mechanical ventilation, and one-quarter had a significant coagulopathy. Features and benefits [12] reported duration of drainage ranged from one to ten days. Seaton et al. All procedures were done at the bedside under local anesthesia and without radiologie guidance. Conclusion. Chest radiographs were done before and after the procedure to determine efficacy of drainage (Figure 1). Tube thoracostomy remains the standard of care for the treatment of pneumothorax and simple effusions in most hospitals.1 The 8.3 French pigtail catheter (Cook Inc., Bloomington, IN) was designed for pericardial drainage but was first applied as an alternative to chest tube placement for the treatment of postoperative pleural effusions on the liver transplant service at our institution. The incidence of blockage was 4.8%. Use of small-bore pigtail catheter is a less invasive way for draining pleural effusions than chest tube thoracostomy. For cases of heart failure, antifailure treatment and diuretics were given. Informed signed consent was obtained from all patients eligible to participate in the study. Liu et al. Coagulopathies (defined as an international normalized ratio greater than 1.5 and/or a platelet count below 80,000/mm3 ) were present at the time of 26/109 (24%) insertions. View more details about the Wayne Pneumothorax Catheter Set and Tray Seldinger. [15] treated 15 consecutive patients with symptomatic malignant pleural effusion using a nine-French catheter. Patz et al. We typically employ a small (22 gauge) finder needle before inserting the larger needle provided with the kit. The process of inserting a catheter is catheterization. Pneumothoraces were resolved spontaneously through the same catheter. A pleural effusion is always abnormal and indicates the presence of an underlying disease. This form is intended for US-based physicians only. Not all products are approved in all regulatory jurisdictions. Treatment of pneumothoraces utilizing small caliber chest tubes, Chest tubes: indications, techniques, management and complications, Chest tube insertion: a prospective evaluation of pain management, JSLS : Journal of the Society of Laparoscopic & Robotic Surgeons, http://creativecommons.org/licenses/by-nc-nd/3.0/, Persistent PTX after 72 hours, resolved with CT, Ongoing air leak/PTX at 48 hours, 2nd pigtail unsuccessful, 2 Cts placed: persistent air leak; ARDS, death, advanced COPD, pneumonia, PTX after central line, Persistent PTX/air leak at 48 hours; required 3 Cts / 19 days to resolve PTX, anorectal cancer, PTX after central line placement, Initial success; recurrent PTX at 96 hours (pigtail sideholes migrated outside thorax); resolved with CT, 3 days s/p CABG; bilat PTX after CT removal, Left pigtail successful; right pigtail failed; CT successful, Pigtail # drained 550 cc/24hrs, then displaced to chest wall Pigtail #2: minimal drainage; CT & CAT-guided pigtail successful, Pigtail successful, removed with 1 liter/day output; 2nd pigtail successful, metastatic breast cancer: bilateral effusions, Left pigtail successful; Right failed: loculated collection required ultrasound-guided drainage w/ 8F catheter, Effusion drained: persistent air leak resolved with 2nd pigtail, Minimal drainage with pigtail; CT also failed: thoracotomy for large hemothorax, Pigtail sideholes extrapleural; CT unsuccessful; U/S guided thoracentesis fails: death from sepsis, Effusion resolved with pigtail: removed 48 hours after placement; pneumothorax 24 hours later resolved w/ CT, 1 month s/p hepatic lobectomy: R effusion, U/S catheter drainage failed; pigtail->partial drainage; CAT-guided 10F catheters x 2 failed (loculated collection); VATS successful, Pigtail successful 72 hours: pulled out on bedrail; residual fluid removed with thoracentesis, Pigtail successful, removed with 1600 cc/day output; second pigtail successful. Source: Regenstrief LOINC, LP21378-2 Catheter On reviewing the literatures, pigtail catheter insertion was usually safe with little chance for complications. Pigtail catheters have a comparable efficacy to chest tubes in patients with pneumothorax.*. The most proximal side hole is positioned on the radiopaque stripe to aid in confirming catheter positioning via x-ray.
The 8.5 Fr catheter is designed for smaller patient anatomies. There was no significant difference in success rate when different catheter sizes were used to treat pleural diseases. Clinical success rates were high and comparable to previously reported rates for tube thoracostomy.9 For effusions in the current series, 86 percent of initial pigtail placements were clinically successful. 5 Seldinger placement facilitates controlled, minimally invasive catheter introduction. The set comes with the Cook Chest Drain Valve, which is designed to help remove air from the pleural cavity. The 8.3 French pigtail catheter (Cook Inc., Bloomington, IN; C-PCS-830-LOCK). [12] used a 14F pigtail catheter in ten patients with malignant pleural effusion in an ambulatory base and after that pleurodesis was done with talc. Seldinger placement facilitates controlled, minimally invasive catheter introduction.
The success rate was highest with transudative pleural effusion (12 out of 14, 85.71%), followed by tuberculous effusion (five out of six, 83.33%), then malignant pleural effusion (nine out of 11, 81.81%), and finally parapneumonic pleural effusion (16 out of 20, 80%) (Figure 2). Eleven of 12 patients who lived for more than four weeks had objective clinical responses. On the contrary, Lai et al. Seldinger placement facilitates controlled, minimally invasive catheter introduction. J Trauma. In both parapneumonic and tuberculous pleural effusion groups, all failures were associated with presence of loculation (Table 2). The catheter is constructed of polyethylene and has six sideholes at the distal end. government site. Pain caused by chest drain insertion is less with using pigtail catheters as they do not impinge on the neurovascular bundle or alter the geometry of the intercostals space. Features and benefits Tube thoracostomy remains the standard of care for the treatment of pneumothoraces and simple effusions. Mean age was 56.3 years (range 16 to 80 years). There were no complications related to pigtail catheter insertion. Used to provide separate sampling or an infusion port within Thal-Quick chest tubes. Pneumothoraces were resolved spontaneously through the same catheter. Although sporadic reports supporting the use of small-bore catheters for thoracic drainage have appeared in the literature, this technique has not enjoyed widespread application in clinical practice.
Catheterization and angiography device panel. One should have a low threshold for additional radiographie study of a pleural fluid collection that does not respond to initial drainage maneuvers. The new PMC design is here! View more details about the Lock Pericardiocentesis Set and Tray. 67-year-old male with transudative effusion due to hypoproteinemia caused by chronic liver disease. Seldinger placement facilitates controlled, minimally invasive catheter introduction. We retrospectively reviewed 109 consecutive pigtail catheter placements. sharing sensitive information, make sure youre on a federal Saffran et al. No related content is available yet for this article. Walsh et al. Used for connection to other medical devices such as catheters. A 24 F chest tube (the smallest size commonly used for the described indications) has an outer diameter of 8 mm, while a 32 F chest tube has an outer diameter of just under 11 mm. [11] found a mean duration of drainage of 97 hours. The 40 cm long catheter is designed to cater to larger patient anatomies. 41-year-old female with transudative effusion due to heart failure. Patz et al. In the present study, pigtail catheter drainage of pleural effusion was successful in 82.35% of cases. In another study, Liang et al. Treatment details are outlined in Table 1.
The site of catheter insertion was determined according to ultrasound findings. The pneumothorax group included: central line-related (10), trauma (9), spontaneous (7), and postoperative (6). We offer an extensive line of chest tubes for removing both air and fluid from the pleural and pericardial spaces. Prospectively, we evaluated efficacy and safety of pigtail catheter (8.514 French) insertion in 51 cases of pleural effusion of various etiologies. Sign Up. about navigating our updated article layout. [13] published a series of 19 patients with malignant effusions who underwent ambulatory pleurodesis (with bleomycin) using small-bore (10.3F) catheter drainage. View more details about the Fuhrman Pleural/PneumopericardialDrainage Setand Tray. View each products indications for use, specifications, components, and other resources by clicking the links below. The set comes with the Cook Chest Drain Valve, which is designed to help remove air from the pleural cavity. Different catheters have different combinations of stiffness, diameter, angle and shape. Tube thoracostomy remains the standard of care for the treatment of pneumothorax and simple effusions in most hospitals [4].
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. Resolution occurred in 22 patients. Fifty-one of 109 patients (47%) were mechanically ventilated and 26 patients (24%) had a coagulopathy. official website and that any information you provide is encrypted Pigtail catheter are named for the tight coil at the end of the catheter that resembles a pig's tail. Pigtail catheters have been shown to have a comparable efficacy to chest tubes in patients with pneumothorax.*. Pigtail catheter was blocked with failure of the drainage. When pleural effusion is detected, the characteristics of the fluid (exudate or transudate) must be revealed using thoracocentesis [1]. There are six side holes at the distal end of the catheter. Review of failures in both groups (Table 2) suggests that refinement of patient selection and management strategies would yield even higher success rates for the treatment of both pneumothoraces and effusions. 2011;71(5):11041107. Salient technical aspects of pigtail catheter insertion include appropriate use of local anesthetic and needle insertion that barely walks over the top of the rib to avoid the intercostal bundle. In our study, the mean duration of pleural fluid drainage using pigtail catheter was 5.8 days (314 days). Used for the evacuation of air from the pericardial sac orthe drainage of air or fluid from the pleural space. 2012, Article ID 143295, 6 pages, 2012. https://doi.org/10.5402/2012/143295, 1Chest Department, Faculty of Medicine, Tanta University, Tanta 33633, Egypt, 2Internal Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt. Patz et al. Chest tubes, with their excessive size, cause pain by compressing the neurovascular bundle at the top of the interspace, as well as by levering open the interspace. We found that exclusion of patients with preplacement evidence of loculated effusions would have yielded a success rate of 91.3% for effusions treated by pigtail catheter drainage. *Kulvatunyou N, Vijayasekaran A, Hansen A, et al. View more details about the Catheter Aspiration Set for Simple Pneumothorax. Overall success rate was 82.35% (85.71% for transudative, 83.33% for tuberculous, 81.81% for malignant, and 80% for parapneumonic effusion). The pigtail catheter is attached to a standard thoracic drainage system and suction applied for pneumothoraces. mL (Table 1). [16] found that the complication rate was low and consisted of symptoms such as pain and fever with using small tube drainage and doxycycline sclerotherapy. Gammie et al. Exclusion of the two patients (three catheter placements) with severe underlying parenchymal disease and prevention of pigtail migration in the fourth would have yielded a success rate of 30/32, or 94% for pneumotho-races. The high clinical success rate combined with the absence of insertion-related complications strongly supports broader use of the pigtail catheter for drainage of simple effusions and pneumothoraces. For malignant pleural effusion, pleurodesis was done using bleomycin (0.75mg/kg was administered as a single dose. Address reprint request to: James D. Luketich, MD, Section of Thoracic Surgery and The Minimally Invasive Center, University of Pittsburgh Medical Center, 300 Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA. Get Email about News, Products, and Events from Cook Medical. Telephone: (412) 648-6736, Fax: (412) 648-6761, E-mail: This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License (, Pneumothorax, Pleural effusion, Catheter, Drainage, Determining the size of pneumothorax in the upright patient, Emergency treatment of pneumothorax: a simple catheter technique for use in the radiology department, New pigtail catheter for pleural drainage in pediatrie patients. Eight of 13 effusions were adequately treated using the small-bore catheter, compared with four of 11 effusions treated with the standard chest tube. In accordance with the results of our study, Sartori et al. Treatment details of patients undergoing insertion of pigtail catheters for pneumothorax or simple effusion. Fourteen cases had transudative pleural effusion; eight secondary to heart failure and six secondary to hypoproteinemia. I. Gotsman, Z. Fridlender, A. Meirovitz, D. Dratva, and M. Muszkat, The evaluation of pleural effusions in patients with heart failure,, M. L. Mayse, Non-malignant pleural effusions, in, V. C. Broaddus and R. W. Light, Pleural effusion, in, J. S. Roberts, S. L. Bratton, and T. V. Brogan, Efficacy and complications of percutaneous pigtail catheters for thoracostomy in pediatric patients,, S. I. Seldinger, Catheter replacement of the needle in percutaneous arteriography; a new technique,, D. Laws, E. Neville, and J. Duffy, BTS guidelines for the insertion of a chest drain,, L. A. Mandell, R. G. Wunderink, A. Anzueto et al., Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the management of community-acquired pneumonia in adults,, W. Parulekar, G. Di Primio, F. Matzinger, C. Dennie, and G. Bociek, Use of small-bore vs large-bore chest tubes for treatment of malignant pleural effusions,, Y. H. Liu, Y. C. Lin, S. J. Liang et al., Ultrasound-guided pigtail catheters for drainage of various pleural diseases,, J. S. Gammie, M. C. Banks, C. R. Fuhrman et al., The pigtail catheter for pleural drainage: a less invasive alternative to tube thoracostomy,, L. Saffran, D. E. Ost, A. M. Fein, and M. J. Schiff, Outpatient pleurodesis of malignant pleural effusions using a small-bore pigtail catheter,, E. F. Patz, H. P. McAdams, P. C. Goodman, S. Blackwell, and J. Crawford, Ambulatory sclerotherapy for malignant pleural effusions,, J. D. Luketich, M. Kiss, J. Hershey et al., Chest tube insertion: a prospective evaluation of pain management,, F. W. Walsh, W. M. Alberts, D. A. Solomon, and A. L. Goldman, Malignant pleural effusions: pleurodesis using a small-bore percutaneous catheter,, K. G. Seaton, E. F. Patz, and P. C. Goodman, Palliative treatment of malignant pleural effusions: value of small-bore catheter thoracostomy and doxycycline sclerotherapy,, Y. C. Chang, E. F. Patz, and P. C. Goodman, Pneumothorax after small-bore catheter placement for malignant pleural effusions,, M. C. Morrison, P. R. Mueller, M. J. Lee et al., Sclerotherapy of malignant pleural effusion through sonographically placed small-bore catheters,, W. H. Warren, R. Kalimi, L. M. Khodadadian, and A. W. Kim, Management of malignant pleural effusions using the pleurx catheter,, S. J. Liang, C. Y. Tu, H. J. Chen et al., Application of ultrasound-guided pigtail catheter for drainage of pleural effusions in the ICU,, C. J. Grodzin and R. A. The radiopaque catheter material enhances x-ray visualization. Careers, Division of Cardiothoracic Surgery University of Pittsburgh Medical Center Pittsburgh, PA. Duration of drainage of pleural fluid was 314 days. The sideports are positioned at the distal end of the chest tube. An official website of the United States government. 45-year-old male with tuberculous pleural effusion (loculated). In medicine, a catheter is a tube that can be inserted into a body cavity duct or vessel. We do not use the pigtail catheter on newly postoperative patients, trauma patients, or patients with suspected hemorrhagic effusions.
Balk, Indwelling small pleural catheter needle thoracentesis in the management of large pleural effusions,, C. L. Chung, C. H. Chen, C. Y. Yeh, J. R. Sheu, and S. C. Chang, Early effective drainage in the treatment of loculated tuberculous pleurisy,, Y. F. Lai, T. Y. Chao, Y. H. Wang, and A. S. Lin, Pigtail drainage in the treatment of tuberculous pleural effusions: a randomised study,, S. Sartori, D. Tassmari, P. Ceccotti et al., Prospective randomized trial of intrapleural bleomycin versus interferon alfa-2b via ultrasound-guided small-bore chest tube in the palliative treatment of malignant pleural effusions,, L. A. Parker, G. C. Charnock, and D. J. Delany, Small bore catheter drainage and sclerotherapy for malignant pleural effusions,. [10] reviewed 276 patients who underwent pigtail catheters (size from ten to 16 French) under ultrasound guidance for drainage of pleural effusions of various etiologies and pneumothoraces. Normal liquid and protein enter pleura space from the systemic circulation and are removed by the parietal pleural lymphatics. Mean pneumothorax size diminished from 38 to 1 percent during an average 71-hour placement. The enlarged sideports are designed to facilitate the drainage of air. 2011;71(5):11041107. Features and benefits Read the winning articles. The set comes with the Cook Chest Drain Valve, which is designed to help remove air from the pleural cavity. Success rates of using pigtail catheter in other studies were comparable to our findings. The radiopaque catheter material enhances x-ray visualization. days. [5] found that five percent of pigtail catheter placements were associated with serious complications (hemothorax, pnuemothorax, and hepatic perforation) and the overall complications of catheter use occurred in 20% of patients and included failure to drain, dislodgement, kinking, empyema, and disconnection. FOIA The https:// ensures that you are connecting to the Sargent reported using a 9 F catheter to treat pneumothoraces in 1970.3 Lawless and colleagues from the University of Pittsburgh used an 8.5 F pigtail catheter for the treatment of pneumothorax in 16 neonates and small children with a high success rate.4 Robinson applied Tenckhoff catheters for palliative drainage of malignant pleural effusion in nine patients.5 Martin reported the use of a small-bore 13 F catheter with an integral one-way valve for the treatment of simple pneumothoraces in 84 patients.6 All catheters were placed in the second intercostal space in the midclavicular line. Pigtail catheter drainage of pleural effusion was successful in 42 out of 51 patients with a success rate of 82.35%. Warren et al. Experience on the liver transplant service at our institution suggested that pneumothoraces and simple effusions could be successfully treated with the 8.3 F pigtail catheter. Features and benefits The 8.3 F pigtail catheter is now our method of choice for draining air and free-flowing simple effusions from the pleural space. HHS Vulnerability Disclosure, Help Centimeter markings on the pigtail catheter guide insertion. The radiopaque catheter material enhances x-ray visualization. Copyright Text is available under the Creative Commons Attribution/Share-Alike License.
Development of an adequate tract with the dilator and insertion of the pigtail so that the sideholes are well within the pleural cavity are important for proper function. The pigtail catheter may have utility for exudative (stage I, American Thoracic Society) empyemas, although our limited experience treating this entity with small-bore catheter drainage precludes a definitive conclusion; stage II (fibrinopurulent) and stage III (organized) empyemas require more invasive management. Fluid reaccumulated indicating failure of pleurodesis. 4 Used for emergency relief and temporary managementof suspected tension pneumothorax. The current study reviews our experience with 109 catheters inserted in 86 patients over a nine-month period. Nonlayering effusions should be drained with radiographie guidance. Used to infuse or withdraw rinsing solutions in theperitoneal cavity. One hundred and nine pigtail catheters were placed in 86 patients during the nine-month study period. The centimeter-marked dilators allow for additional control over the insertion of a chest tube into the pleural space. One patient had a wound infection and empyema that necessitated hospitalization for six days. Future studies are needed to compare pigtail catheter and other small bore drains with and without using Seldinger technique. There are a variety of coronary catheters available for different use cases. The current study reviews our experience with 51 cases having pigtail catheters inserted for treatment of pleural effusion over a sixteen-month period. No significant insertion complications, such as hollow organ perforation, were caused by this procedure. If the cases of loculated pleural effusions are excluded, the success rate increases to 91.3% (42 out of 46). [10] reported a mean duration of drainage of 6.1 days. [16] studied the use of small tube drainage and doxycycline sclerotherapy for malignant pleural effusion and reported a success rate of 81%. Among the six cases of empyema, the procedure was successful only in two of them (success rate 33.33%). Used in conjunction with a pneumothorax aspiration catheter if incomplete expansion of the lung persists after mechanical aspiration of air. For hypoproteinemia cases, albumin infusion and diuretics were given. Among the six cases of empyema, the procedure was successful only in two of them (success rate 33.33%). 8 The radiopaque catheter material enhances x-ray visualization. Parker et al. In practice, however, with free-flowing effusions and pneumothoraces (in which there is free communication throughout the pleural space), we have not found the site of placement of the pigtail catheter to have any bearing on procedural success. The pigtail catheter offers reliable treatment of pneumothoraces and simple effusions and is a safe and less invasive alternative to tube thoracostomy. No patients were mechanically ventilated. Pigtail catheter insertion is an effective and safe method of draining pleural fluid.
Before In another study, Morrison et al. The catheter material has radiopaque properties. Results. 2 67-year-old male with malignant pleural effusion. The enlarged sideports are designed to facilitate the drainage of air. Parulekar et al. View more details about the Thal-Quick Chest Tube Set and Tray. Used for the relief of simple, spontaneous, iatrogenic, and tension pneumothorax. You will be leaving the Cook Medical website that you were viewing and going to a Cook Medical website for another region or country. Conces et al. Adoption of this technique will provide the clinician with a valuable addition to his/her armamentarium that allows effective pleural drainage with minimal patient discomfort. Similarly, 81 percent of pigtails inserted for pneumothoraces were successful. [11] found that clinical success rates of pigtail catheter insertion for drainage of pleural effusion were 86% with no reported complications. Reaccumulation of the pleural effusion occurred in 3.8% of cases. The The local ethical committee approved the study protocol. The site is secure. In our hands, the pigtail catheter yielded rapid radiographie resolution of both pneumothoraces and pleural effusions. The Thal-Quick Chest Tube Adapter is sold separately. [13] reported a duration of catheter drainage of two to 11 days (mean 5.1 days). In other studies, the durations of drainage of pleural fluid using a pigtail catheter were more or less similar to our results. in [13] reported a success rate of 79% with the use of ambulatory pigtail catheter and pleurodesis for malignant effusions. [25] compared the efficacy of small-bore catheter drainage and pleurodesis to traditional drainage with standard chest tube in 24 malignant pleural effusions. Catheters were inserted under local anesthesia at the bedside without radiographie guidance. Copyright 2022 Regenstrief Institute, Inc. All Rights Reserved. Fluid re-accumulated indicating failure of pleurodesis. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. * 4 Seaton et al. This report describes a favorable experience with the 8.3 French pigtail catheter as a less invasive alternative to traditional chest tube insertion. Liu et al. [9] found that small-bore catheter 12 French was as effective as standard chest tube for drainage of malignant pleural effusion and pleurodesis without significant differences in the rate of complications. One patient experienced reexpansion pulmonary edema. 9 59-year-old male with empyema with loculations. These patients were quite ill: one-half were on mechanical ventilation, and one-quarter had a significant coagulopathy. Features and benefits [12] reported duration of drainage ranged from one to ten days. Seaton et al. All procedures were done at the bedside under local anesthesia and without radiologie guidance. Conclusion. Chest radiographs were done before and after the procedure to determine efficacy of drainage (Figure 1). Tube thoracostomy remains the standard of care for the treatment of pneumothorax and simple effusions in most hospitals.1 The 8.3 French pigtail catheter (Cook Inc., Bloomington, IN) was designed for pericardial drainage but was first applied as an alternative to chest tube placement for the treatment of postoperative pleural effusions on the liver transplant service at our institution. The incidence of blockage was 4.8%. Use of small-bore pigtail catheter is a less invasive way for draining pleural effusions than chest tube thoracostomy. For cases of heart failure, antifailure treatment and diuretics were given. Informed signed consent was obtained from all patients eligible to participate in the study. Liu et al. Coagulopathies (defined as an international normalized ratio greater than 1.5 and/or a platelet count below 80,000/mm3 ) were present at the time of 26/109 (24%) insertions. View more details about the Wayne Pneumothorax Catheter Set and Tray Seldinger. [15] treated 15 consecutive patients with symptomatic malignant pleural effusion using a nine-French catheter. Patz et al. We typically employ a small (22 gauge) finder needle before inserting the larger needle provided with the kit. The process of inserting a catheter is catheterization. Pneumothoraces were resolved spontaneously through the same catheter. A pleural effusion is always abnormal and indicates the presence of an underlying disease. This form is intended for US-based physicians only. Not all products are approved in all regulatory jurisdictions. Treatment of pneumothoraces utilizing small caliber chest tubes, Chest tubes: indications, techniques, management and complications, Chest tube insertion: a prospective evaluation of pain management, JSLS : Journal of the Society of Laparoscopic & Robotic Surgeons, http://creativecommons.org/licenses/by-nc-nd/3.0/, Persistent PTX after 72 hours, resolved with CT, Ongoing air leak/PTX at 48 hours, 2nd pigtail unsuccessful, 2 Cts placed: persistent air leak; ARDS, death, advanced COPD, pneumonia, PTX after central line, Persistent PTX/air leak at 48 hours; required 3 Cts / 19 days to resolve PTX, anorectal cancer, PTX after central line placement, Initial success; recurrent PTX at 96 hours (pigtail sideholes migrated outside thorax); resolved with CT, 3 days s/p CABG; bilat PTX after CT removal, Left pigtail successful; right pigtail failed; CT successful, Pigtail # drained 550 cc/24hrs, then displaced to chest wall Pigtail #2: minimal drainage; CT & CAT-guided pigtail successful, Pigtail successful, removed with 1 liter/day output; 2nd pigtail successful, metastatic breast cancer: bilateral effusions, Left pigtail successful; Right failed: loculated collection required ultrasound-guided drainage w/ 8F catheter, Effusion drained: persistent air leak resolved with 2nd pigtail, Minimal drainage with pigtail; CT also failed: thoracotomy for large hemothorax, Pigtail sideholes extrapleural; CT unsuccessful; U/S guided thoracentesis fails: death from sepsis, Effusion resolved with pigtail: removed 48 hours after placement; pneumothorax 24 hours later resolved w/ CT, 1 month s/p hepatic lobectomy: R effusion, U/S catheter drainage failed; pigtail->partial drainage; CAT-guided 10F catheters x 2 failed (loculated collection); VATS successful, Pigtail successful 72 hours: pulled out on bedrail; residual fluid removed with thoracentesis, Pigtail successful, removed with 1600 cc/day output; second pigtail successful. Source: Regenstrief LOINC, LP21378-2 Catheter On reviewing the literatures, pigtail catheter insertion was usually safe with little chance for complications. Pigtail catheters have a comparable efficacy to chest tubes in patients with pneumothorax.*. The most proximal side hole is positioned on the radiopaque stripe to aid in confirming catheter positioning via x-ray.
The 8.5 Fr catheter is designed for smaller patient anatomies. There was no significant difference in success rate when different catheter sizes were used to treat pleural diseases. Clinical success rates were high and comparable to previously reported rates for tube thoracostomy.9 For effusions in the current series, 86 percent of initial pigtail placements were clinically successful. 5 Seldinger placement facilitates controlled, minimally invasive catheter introduction. The set comes with the Cook Chest Drain Valve, which is designed to help remove air from the pleural cavity. The 8.3 French pigtail catheter (Cook Inc., Bloomington, IN; C-PCS-830-LOCK). [12] used a 14F pigtail catheter in ten patients with malignant pleural effusion in an ambulatory base and after that pleurodesis was done with talc. Seldinger placement facilitates controlled, minimally invasive catheter introduction.
The success rate was highest with transudative pleural effusion (12 out of 14, 85.71%), followed by tuberculous effusion (five out of six, 83.33%), then malignant pleural effusion (nine out of 11, 81.81%), and finally parapneumonic pleural effusion (16 out of 20, 80%) (Figure 2). Eleven of 12 patients who lived for more than four weeks had objective clinical responses. On the contrary, Lai et al. Seldinger placement facilitates controlled, minimally invasive catheter introduction. J Trauma. In both parapneumonic and tuberculous pleural effusion groups, all failures were associated with presence of loculation (Table 2). The catheter is constructed of polyethylene and has six sideholes at the distal end. government site. Pain caused by chest drain insertion is less with using pigtail catheters as they do not impinge on the neurovascular bundle or alter the geometry of the intercostals space. Features and benefits Tube thoracostomy remains the standard of care for the treatment of pneumothoraces and simple effusions. Mean age was 56.3 years (range 16 to 80 years). There were no complications related to pigtail catheter insertion. Used to provide separate sampling or an infusion port within Thal-Quick chest tubes. Pneumothoraces were resolved spontaneously through the same catheter. Although sporadic reports supporting the use of small-bore catheters for thoracic drainage have appeared in the literature, this technique has not enjoyed widespread application in clinical practice.