Efficacy and Complications of Small-Bore, Wire-Guided Chest Drains

doi:10.1378/chest.130.6.1857

Chest

Volume 130, Issue 6, December 2006, Pages 1857-1863

https://doi.org/10.1378/chest.130.6.1857 Get rights and content

Background

Small-bore Seldinger-type chest drains have become increasingly popular in recent years, but there are few data on their effectiveness.

Methods

Data were collected prospectively at the time of drain insertion and continued until drain removal. Patients completed a visual analog score (VAS) of pain on drain insertion.

Results

Fifty-two drains were inserted in 44 patients over 10 months. Drain sizes ranged from 12 to 20F. The mean (± SEM) patient age was 64 ± 2 years, and mean duration of drainage was 4.5 ± 0.5 days. Fourteen drains (27%) were inserted for pneumothoraces, 19 drains (37%) for malignant effusions, 10 drains (19%) for empyema, 5 drains (10%) for parapneumonic effusions, and 4 drains (8%) for other effusions. Pain VAS ranged from 3 to 66 mm (maximum, 100 mm; average [± SD], 23 ± 16 mm). Although the overall drain failure rate was 37%, there was only one serious complication (empyema), and this compares well with historical control subjects. Success rate was highest when used to treat malignant effusions (83%) and pneumothoraces (64%); drains inserted for empyema were more likely to block (overall success rate, 20%). There was no correlation between the type of fluid or size of drain and likelihood of blockage.

Conclusions

Seldinger-type drains are a well-tolerated and effective method of draining pneumothoraces and uncomplicated effusions. They are more likely to block when draining empyemas but have a comparable failure rate in pneumothorax to large-bore drains.

Section snippets

Materials and Methods

The study was carried out in a medium-sized UK general hospital of 718 beds. There is no on-site cardiothoracic surgical service, and patients requiring cardiothoracic intervention are transferred to a nearby tertiary care center. The only chest drains used routinely were Cook Thal-Quick chest tubes (Cook Critical Care; Bloomington, IN), ranging in size from 12 to 20F (internal diameter, 2.9 to 4.5 mm; external diameter, 4.0 to 6.7 mm). In addition, central metal trocar-containing tubes (Argyle

Results

Complete data were available on 52 drains in 44 patients (8 repeat drains). In two further cases, drains were reported but little or no additional detail recorded; these were not included in the study. Patients ranged in age from 16 to 85 years (mean ± SEM age, 63.8 ± 2.3 years). Mean drain size was 14.8F (range, 12 to 20F), but the majority of drains used (85%) were size 16F or less (Fig 1).

The most common indications for drain insertion were pneumothoraces or malignant effusions (Fig 2).

Discussion

It was our original intent to collect data on large-bore (> 24F) trocar-containing drains inserted in the same hospital, but during the course of the study none of these chest tubes were reported as having been inserted. This may be partly due to having a range of sizes available using the Seldinger technique (12 to 20F) but probably also reflects training and experience on many medical wards. This study thus represents a prospective assessment of Seldinger drain use and efficacy on medical

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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

None of the authors have any conflicts of interest to disclose.

This work was performed at York District Hospital, York, UK.

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Chest

Original Research: Interventional PulmonologyEfficacy and Complications of Small-Bore, Wire-Guided Chest Drains

Background

Methods

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Chest

Am J Surg

Ann Emerg Med

Am J Emerg Med

Chest

Clin Radiol

Lancet

Respir Med

Clin Radiol

Chest

BTS guidelines for the management of spontaneous pneumothorax

Thorax

BTS guidelines for the management of malignant pleural effusions

Thorax

Original Research: Interventional Pulmonology
Efficacy and Complications of Small-Bore, Wire-Guided Chest Drains