Semin intervent Radiol 2022; 39(03): 234-247
DOI: 10.1055/s-0042-1751295
Review Article

Percutaneous Chest Tube for Pleural Effusion and Pneumothorax

Ifechi Ukeh
1   Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
,
Adam Fang
1   Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
,
Sandhya Patel
2   Naval Medical Center, Aviation Medicine, San Diego, California
,
Kwaku Opoku
1   Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
,
Nariman Nezami
1   Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
› Author Affiliations

Abstract

Chest tubes are placed in the pleural space to evacuate abnormal fluid or air accumulations. Various types and sizes of chest tubes are available. Imaging including ultrasound, computed tomography, and fluoroscopy should be used to guide chest tube placement. Understanding the anatomy of the pleural space, along with the etiology and classification of pleural space disease, can help optimize chest tube management. This article will review the indications, contraindications, techniques, and postprocedure follow-up of chest tube placement as well as discuss the management and prevention of complications.



Publication History

Article published online:
31 August 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Albertine KH, Wiener-Kronish JP, Bastacky J, Staub NC. No evidence for mesothelial cell contact across the costal pleural space of sheep. J Appl Physiol (1985) 1991; 70 (01) 123-134
  • 2 Kookoolis AS, Puchalski JT, Murphy TE, Araujo KL, Pisani MA. Mortality of hospitalized patients with pleural effusions. J Pulm Respir Med 2014; 4 (03) 184
  • 3 Light RW, Macgregor MI, Luchsinger PC, Ball Jr WC. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 1972; 77 (04) 507-513
  • 4 Vives M, Porcel JM, Vicente de Vera M, Ribelles E, Rubio M. A study of Light's criteria and possible modifications for distinguishing exudative from transudative pleural effusions. Chest 1996; 109 (06) 1503-1507
  • 5 Blackmore CC, Black WC, Dallas RV, Crow HC. Pleural fluid volume estimation: a chest radiograph prediction rule. Acad Radiol 1996; 3 (02) 103-109
  • 6 Baumann MH, Strange C, Heffner JE. et al; AACP Pneumothorax Consensus Group. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest 2001; 119 (02) 590-602
  • 7 Omar HR, Abdelmalak H, Mangar D, Rashad R, Helal E, Camporesi EM. Occult pneumothorax, revisited. J Trauma Manag Outcomes 2010; 4: 12
  • 8 Lichtenstein DA, Mezière G, Lascols N. et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med 2005; 33 (06) 1231-1238
  • 9 Yu H. Management of pleural effusion, empyema, and lung abscess. Semin Intervent Radiol 2011; 28 (01) 75-86
  • 10 Park CB, Moon MH, Jeon HW. et al. Does oxygen therapy increase the resolution rate of primary spontaneous pneumothorax?. J Thorac Dis 2017; 9 (12) 5239-5243
  • 11 Zhang M, Teo LT, Goh MH, Leow J, Go KTS. Occult pneumothorax in blunt trauma: is there a need for tube thoracostomy?. Eur J Trauma Emerg Surg 2016; 42 (06) 785-790
  • 12 Hogg JR, Caccavale M, Gillen B. et al. Tube thoracostomy: a review for the interventional radiologist. Semin Intervent Radiol 2011; 28 (01) 39-47
  • 13 Navin PJ, White ML, Nichols FC. et al. Periprocedural major bleeding risk of image-guided percutaneous chest tube placement in patients with an elevated international normalized ratio. J Vasc Interv Radiol 2019; 30 (11) 1765-1768
  • 14 Shalli S, Saeed D, Fukamachi K. et al. Chest tube selection in cardiac and thoracic surgery: a survey of chest tube-related complications and their management. J Card Surg 2009; 24 (05) 503-509
  • 15 Rahman NM, Maskell NA, Davies CW. et al. The relationship between chest tube size and clinical outcome in pleural infection. Chest 2010; 137 (03) 536-543
  • 16 Chang SH, Kang YN, Chiu HY, Chiu YH. A systematic review and meta-analysis comparing pigtail catheter and chest tube as the initial treatment for pneumothorax. Chest 2018; 153 (05) 1201-1212
  • 17 Vedam H, Barnes DJ. Comparison of large- and small-bore intercostal catheters in the management of spontaneous pneumothorax. Intern Med J 2003; 33 (11) 495-499
  • 18 Horsley A, Jones L, White J, Henry M. Efficacy and complications of small-bore, wire-guided chest drains. Chest 2006; 130 (06) 1857-1863
  • 19 Davies HE, Merchant S, McGown A. A study of the complications of small bore ‘Seldinger’ intercostal chest drains. Respirology 2008; 13 (04) 603-607
  • 20 Cafarotti S, Dall'Armi V, Cusumano G. et al. Small-bore wire-guided chest drains: safety, tolerability, and effectiveness in pneumothorax, malignant effusions, and pleural empyema. J Thorac Cardiovasc Surg 2011; 141 (03) 683-687
  • 21 Bauman ZM, Kulvatunyou N, Joseph B. et al. A prospective study of 7-year experience using percutaneous 14-French pigtail catheters for traumatic hemothorax/hemopneumothorax at a level-1 trauma center: size still does not matter. World J Surg 2018; 42 (01) 107-113
  • 22 Diacon AH, Brutsche MH, Solèr M. Accuracy of pleural puncture sites: a prospective comparison of clinical examination with ultrasound. Chest 2003; 123 (02) 436-441
  • 23 Collins JD, Shaver ML, Disher AC, Miller TQ. Fluoroscopic chest tube insertion and patient care. J Natl Med Assoc 1992; 84 (10) 869-872
  • 24 John M, Razi S, Sainathan S, Stavropoulos C. Is the trocar technique for tube thoracostomy safe in the current era?. Interact Cardiovasc Thorac Surg 2014; 19 (01) 125-128
  • 25 Ortner CM, Ruetzler K, Schaumann N. et al. Evaluation of performance of two different chest tubes with either a sharp or a blunt tip for thoracostomy in 100 human cadavers. Scand J Trauma Resusc Emerg Med 2012; 20 (01) 10
  • 26 Dugan KC, Laxmanan B, Murgu S, Hogarth DK. Management of persistent air leaks. Chest 2017; 152 (02) 417-423
  • 27 Mentzer SJ, Tsuda A, Loring SH. Pleural mechanics and the pathophysiology of air leaks. J Thorac Cardiovasc Surg 2018; 155 (05) 2182-2189
  • 28 Lang P, Manickavasagar M, Burdett C, Treasure T, Fiorentino F. UK Cardiothoracic Trainees' Research Collaborative. UK Cardiothoracic Trainees' Research Collaborative. Suction on chest drains following lung resection: evidence and practice are not aligned. Eur J Cardiothorac Surg 2016; 49 (02) 611-616
  • 29 Deng B, Tan QY, Zhao YP, Wang RW, Jiang YG. Suction or non-suction to the underwater seal drains following pulmonary operation: meta-analysis of randomised controlled trials. Eur J Cardiothorac Surg 2010; 38 (02) 210-215
  • 30 Zhou J, Chen N, Hai Y. et al. External suction versus simple water-seal on chest drainage following pulmonary surgery: an updated meta-analysis. Interact Cardiovasc Thorac Surg 2019; 28 (01) 29-36
  • 31 Hallifax RJ, McKeown E, Sivakumar P. et al. Ambulatory management of primary spontaneous pneumothorax: an open-label, randomised controlled trial. Lancet 2020; 396 (10243): 39-49
  • 32 McKenna Jr RJ, Fischel RJ, Brenner M, Gelb AF. Use of the Heimlich valve to shorten hospital stay after lung reduction surgery for emphysema. Ann Thorac Surg 1996; 61 (04) 1115-1117
  • 33 Baringer K, Talbert S. Chest drainage systems and management of air leaks after a pulmonary resection. J Thorac Dis 2017; 9 (12) 5399-5403
  • 34 Brunelli A, Salati M, Refai M, Di Nunzio L, Xiumé F, Sabbatini A. Evaluation of a new chest tube removal protocol using digital air leak monitoring after lobectomy: a prospective randomised trial. Eur J Cardiothorac Surg 2010; 37 (01) 56-60
  • 35 Cho HM, Hong YJ, Byun CS, Hwang JJ. The usefulness of Wi-Fi based digital chest drainage system in the post-operative care of pneumothorax. J Thorac Dis 2016; 8 (03) 396-402
  • 36 Havelock T, Teoh R, Laws D, Gleeson F. BTS Pleural Disease Guideline Group. Pleural procedures and thoracic ultrasound: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65 (Suppl. 02) ii61-ii76
  • 37 Cerfolio RJ, Bryant AS. Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output. J Thorac Cardiovasc Surg 2008; 135 (02) 269-273
  • 38 Xie HY, Xu K, Tang JX. et al. A prospective randomized, controlled trial deems a drainage of 300  mL/day safe before removal of the last chest drain after video-assisted thoracoscopic surgery lobectomy. Interact Cardiovasc Thorac Surg 2015; 21 (02) 200-205
  • 39 Cerfolio RJ, Bryant AS, Skylizard L, Minnich DJ. Optimal technique for the removal of chest tubes after pulmonary resection. J Thorac Cardiovasc Surg 2013; 145 (06) 1535-1539
  • 40 Filosso PL, Guerrera F, Sandri A. et al. Errors and complications in chest tube placement. Thorac Surg Clin 2017; 27 (01) 57-67
  • 41 Kesieme EB, Dongo A, Ezemba N, Irekpita E, Jebbin N, Kesieme C. Tube thoracostomy: complications and its management. Pulm Med 2012; 2012: 256878
  • 42 Rombolá CA, Tomatis SB, Honguero Martínez AF, Atance PL. Parapneumonic pleural effusion. Accidental insertion of a chest tube into right pulmonary artery. Eur J Cardiothorac Surg 2008; 34 (04) 903
  • 43 Sakata KK, Reisenauer JS, Kern RM, Mullon JJ. Persistent air leak - review. Respir Med 2018; 137: 213-218
  • 44 Gervais DA, Levis DA, Hahn PF, Uppot RN, Arellano RS, Mueller PR. Adjunctive intrapleural tissue plasminogen activator administered via chest tubes placed with imaging guidance: effectiveness and risk for hemorrhage. Radiology 2008; 246 (03) 956-963
  • 45 Levinson GM, Pennington DW. Intrapleural fibrinolytics combined with image-guided chest tube drainage for pleural infection. Mayo Clin Proc 2007; 82 (04) 407-413
  • 46 Thommi G, Nair CK, Aronow WS, Shehan C, Meyers P, McLeay M. Efficacy and safety of intrapleural instillation of alteplase in the management of complicated pleural effusion or empyema. Am J Ther 2007; 14 (04) 341-345
  • 47 Zuckerman DA, Reed MF, Howington JA, Moulton JS. Efficacy of intrapleural tissue-type plasminogen activator in the treatment of loculated parapneumonic effusions. J Vasc Interv Radiol 2009; 20 (08) 1066-1069
  • 48 Rahman NM, Maskell NA, West A. et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med 2011; 365 (06) 518-526
  • 49 Menger R, Telford G, Kim P. et al. Complications following thoracic trauma managed with tube thoracostomy. Injury 2012; 43 (01) 46-50
  • 50 Remérand F, Luce V, Badachi Y, Lu Q, Bouhemad B, Rouby JJ. Incidence of chest tube malposition in the critically ill: a prospective computed tomography study. Anesthesiology 2007; 106 (06) 1112-1119
  • 51 Echevarria C, Twomey D, Dunning J, Chanda B. Does re-expansion pulmonary oedema exist?. Interact Cardiovasc Thorac Surg 2008; 7 (03) 485-489
  • 52 Mahfood S, Hix WR, Aaron BL, Blaes P, Watson DC. Reexpansion pulmonary edema. Ann Thorac Surg 1988; 45 (03) 340-345
  • 53 Jones PW, Moyers JP, Rogers JT, Rodriguez RM, Lee YC, Light RW. Ultrasound-guided thoracentesis: is it a safer method?. Chest 2003; 123 (02) 418-423