Ultrasound-guided chest tube insertion
Author:
Mikael Häggström [notes 1]
Contents
Planning
Choice of procedure
Pigtail catheter insertion is an effective and safe method of draining pleural fluid. It is encouraged for use in all cases of pleural effusion requiring chest drain except for empyema and other loculated pleural effusions, where it has low success rates.[1]
Coagulation: Low risk of bleedingThis procedure counts as conferring a relatively low risk of clinically significant bleeding.[2] Required lab testProthrombin time (PT or INR):
Lab interpretation
Anticoagulant medication
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Technique
This is an example used in Swedish practice, in this case without use of Seldinger technique:[notes 2]
1. Ask for any allergic reaction to local anesthetics
2. Check proper puncture location with ultrasonography:
- Strive to puncture close to the inferior rib border rather than the superior one, to avoid damage to intercostal nerves and vessels. The direction of the catheter should usually be toward the basal-dorsal parts.
- If the fluid space is wide enough, the thickness of the thoracic wall can be measured in order to subsequently perform anesthesia and catheter insertion without ultrasound guidance.
- The puncture location can be marked by a skin impression (such as a pen with withdrawn nib), or with a skin marker (which may, however, disappear during washing).
3. The skin area is washed with an antiseptic
4. Wear at least sterile gloves, and use sterile coverage on the ultrasound probe
5. Preferably use a pigtail catheter, generally of French gauge around 7 - 10, and fixate a cannula inside it
6. Have a scalpel ready for skin incision
7. Inject local anesthetic, such as 10 - 20 ml of 1% carbocaine, both superficially, at the rib above and below, and by the pleura
8. Make a skin incision large enough for the catheter to pass
9. Insert the catheter with the cannula until reaching within the pleural space.
10. Loosen the cannula from the catheter, and advance the catheter only, generally in dorsal-basal direction.
11. Withdraw the cannula
12. Check for return, and note the color of any fluid. Attach plug, syringe or bag to the external tip.
13. Twist any pigtail of the catheter
14. Fixate the external part to the skin
Report
- Type of anesthesia used.
- Type of catheter, including caliber and any internal locking mechanism such as pigtail.
- Color of the pleural fluid
- Optionally, whether a bag is attached to the external tip, and whether the attachment is clamped or open.
- See also: General notes on reporting
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
- ↑ NU Hospital Group, Sweden
References
- ↑ Bediwy, Adel Salah; Amer, Hesham Galal (2012). "Pigtail Catheter Use for Draining Pleural Effusions of Various Etiologies ". ISRN Pulmonology 2012: 1–6. doi: . ISSN 2090-5777. CC-BY license
- ↑ The coagulation section follows local practice at: NU Hospital Group, Sweden