Comprehensive Review of Pigtail Catheter Management

A comprehensive review of chest tube management was developed to help clinicians better understand the different types of chest tubes, their indications, and key management principles to optimize patient outcomes. With the increasing use of small-bore, "pigtail" catheters in the management of pleural space diseases, there is a growing need for a more focused review that outlines the specific indications, procedural techniques, management strategies, and associated complications of pigtail catheters.

Pigtail catheters are indicated as first-line treatment in a variety of pleural space diseases. Pigtail catheters can drain fluid from the pleural space; they are used to manage transudative pleural effusions, simple exudate pleural effusions, and other low-viscosity fluids. Pigtail catheter insertion using the Seldinger technique can be reliably taught in a systematic fashion. After the pigtail catheter has been inserted and connected to the thoracic drainage system, the location and position of the catheter is confirmed with imaging. Once placement is confirmed, the catheter is connected to a closed thoracic drainage system. While the pigtail catheter is in place, care should be taken to evaluate the entire system daily. The determining factors for removing a pigtail catheter include the quantity and quality of the fluid and resolution of the underlying pathology. Pigtail catheters may need to be uncoiled before removal to avoid tissue injury. Complications associated with the use of pigtail catheters can occur at the time of placement or while the catheter is in place. They can include bleeding, pain, extrapleural placement, injury to surrounding structures, neurovascular injury, infection, dislodgement, or occlusion of the catheter.

Pigtail catheters are going to continue to be an important part in the management of pleural conditions. It is important to understand these devices and specific complications associated with pigtail catheters so clinicians can continue to build their foundation of knowledge on the management of pleural space diseases.