Chest
Clinical Investigations: Pediatric PulmonologyEfficacy and Complications of Percutaneous Pigtail Catheters for Thoracostomy in Pediatric Patients
Section snippets
MATERIALS AND METHODS
The charts of all pediatric patients at Children's Hospital and Medical Center, Seattle, WA, whose discharge diagnosis from the ICU included pneumothorax or pleural effusion were reviewed. All patients who underwent percutaneous pigtail thoracostomy tube placement as the initial therapy for pneumothorax or pleural effusion were included. Patients treated with surgical chest tubes or pigtail catheters placed outside the ICU were excluded. Patient data from January 1996 through August 1997 were
RESULTS
Ninety-one children required 133 percutaneous pigtail catheters. The demographic data are shown in Table 1. Most patients were infants and children following surgery for congenital heart disease. Mechanical ventilation was used for most patients, 61 (67%). The patients required a moderate level of ventilatory support with a median fraction of inspired oxygen of 0.5 and a median positive end-expiratory pressure of 5 cm H2O. Twenty-six of 91 children had a prolonged PT or PTT (29%) at the time of
CONCLUSIONS
The use of thoracostomy tubes for draining pleural fluid or air is an important therapeutic measure that ideally provides effective drainage in a timely manner without complications from the procedure. Traditional large-bore chest tubes, placed by either blunt dissection or by trocar assistance, may have significant morbidity associated with the force required to breech the chest wall and the stiffness of the chest tube itself. Chest tube placement in neonates is particularly difficult, given
ACKNOWLEDGMENT
We would like to acknowledge the assistance of Debbie Ridling, RN, MS, CCNS, of Children's Hospital and Medical Center, for her efforts to improve our use of percutaneous catheters.
REFERENCES (12)
- et al.
Chest tubes: indications, technique, management and complications
Chest
(1987) - et al.
Chest tube thoracostomy
Crit Care Clin
(1992) - et al.
Effectiveness of chest tube evacuation of pneumothorax in neonates
J Pediatr
(1981) - et al.
Analysis of tube thoracostomy performed by pulmonologists at a teaching hospital
Chest
(1997) - et al.
High incidence of lung perforation by chest tube in neonatal pneumothorax
J Pediatr
(1978) - et al.
Complications of tube thoracostomy for acute trauma
Am J Surg
(1980)
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