For the initial management of large pneumothoraces there is wide variations in clinical practice. Some sites use large ‘surgical’ chest tubes (CT) while others use smaller-bore catheters with a trend towards less invasive management. According to a study in American Journal of Emergency Medicine, a 5F central venous catheter work as well as a conventional 14-20F chest tube for drainage of pneumothoraces.
The researchers ICU used chest tubes from 2003 to 2007 before they switched over to inserting CVCs from 2008 to 2010. From this 8 year period they retrospectively screened the patients who had drains for pneumothoraces.
Primary outcome measure was drainage failure, defines as the need for a second drainage procedure or surgery.
The failure rate was the same in both groups. The 112 patients who had an CVV had a failure rate of 19% while the CT-group had a failure rate of 21%. It is also interesting how the CVCs had shorter hospital stays than the CTs. The researchers recommend using small-bore catheters. It works just as well, is minimally invasive and a lot less painful.
Link to the study below. There are some nice references to the very few other studies on the subject.
Am J Emerg Med. 2012 Jan 2. [Epub ahead of print]
Small-bore catheter versus chest tube drainage for pneumothorax.
Contou D, Razazi K, Katsahian S, Maitre B, Mekontso-Dessap A, Brun-Buisson C, Thille AW.