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 study
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.

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