Ultrasound-guided Pleural Effusion Drainage With a Small Catheter Using the Single-step Trocar or Modified Seldinger...

Studies have shown that small-catheter pleural effusion drainage is safe and has a lower complication rate. Our objective was to evaluate the outcomes and the safety of the single-step trocar or the modified Seldinger technique.

A total of 124 patients (83 men and 41 women), with mean age of 46±18 years and mean duration of drainage 5.3±2 days, were include in the study. The trocar technique was attempted in 201 (86.5%) cases, and the modified Seldinger technique was used in 38 (16.5%) cases.

Technical success was obtained in 96% for the trocar technique and in 100% for the modified Seldinger technique. The procedure time for the trocar and the modified Seldinger techniques was approximately 7 and 12 minutes, respectively (P-value=0.02). The overall success rate was 72.9%. The success rate was highest for massive transudative effusions (98%) followed by malignant effusions (87%), and it was least for parapneumonic effusion/empyema (72 %). Pneumothorax occurred in 10.5% (n=4) for modified Seldinger versus 0.5% (n=1) (P=0.12) for trocar, whereas bleeding occurred in 0% for modified Seldinger and in 1% (n=2) for trocar (P=0.04). The single-step trocar technique was technically unsuccessful in 8 cases (7 had empyema with narrow intercostal spaces and one had kyphoscoliosis); technical success was achieved by using the modified Seldinger.

Ultrasound-guided pleural effusion drainage by catheter insertion is a safe and effective procedure. The success rate is low when the effusion is loculated and septated. Both the trocar and the modified Seldinger techniques can be used. The trocar technique is faster and easier.