Chest
Volume 114, Issue 4, October 1998, Pages 1116-1121
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Clinical Investigations: Pediatric Pulmonology
Efficacy and Complications of Percutaneous Pigtail Catheters for Thoracostomy in Pediatric Patients

https://doi.org/10.1378/chest.114.4.1116Get rights and content

Objective

To describe the efficacy of percutaneous pigtail catheters in evacuating pleural air or fluid in pediatric patients.

Design

A case series of children with percutaneous pigtail catheters placed in the pediatric ICU between January 1996 and August 1997.

Setting

Urban pediatric teaching hospital in Seattle, WA.

Methods

A retrospective chart review.

Results

Ninety-one children required 133 chest catheters. Most patients were infants with congenital heart disease (80%). One hundred thirteen of the catheters (85%) were placed for pleural effusion, with 20 tubes (15%) placed for pneumothorax. Efficacy of drainage of pleural fluid was significantly greater in serous (96%) and chylous (100%) effusions compared with empyema (0%) or hemothorax (81%). Evacuation of pneumothorax was achieved by a pigtail catheter in 75% of patients. Resolution of pleural air or pneumothorax was significantly greater in patients < 10 kg compared with larger children. Complications due to placement of the pigtail catheters included hemothorax (n=3, 2%), pneumothorax (n=3, 2%), and hepatic perforation (n=l, 1%). There were also complications arising from the use of the catheters, including failure to drain, dislodgment, kinking, loss of liquid ventilation fluid, empyema, and disconnection in 27 of 133 catheters (20%). Significantly more complications during catheter use occurred in patients <5 kg than in larger children.

Conclusions

Percutaneous pigtail catheters are highly effective in drainage of pleural serous and chylous effusions, somewhat less efficacious in drainage of hemothorax or pneumothorax, and least efficacious in drainage of empyema. Infants and smaller children had higher rates of resolution of pleural air and fluid from placement of a pigtail catheter than larger children. Complications from catheter placement were uncommon (5%) but serious, whereas complications associated with continued use of the catheters were more common (20%) but less grave. Strict attention to anatomic landmarks and close monitoring may reduce the number of complications.

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)

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