Efficacy and complications of percutaneous pigtail catheters for thoracostomy in pediatric patients
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Published on: May 26, 2023
J S Roberts1, S L Bratton, T V Brogan
1Department of Anesthesiology, University of Washington School of Medicine, Children's Hospital and Medical Center, Seattle 98105, USA. jreno@u.washington.edu
Insights
Percutaneous pigtail catheters effectively drain pleural effusions in pediatric patients, especially serous and chylous types. While less effective for pneumothorax and empyema, they offer a viable option for managing pleural air and fluid in children.
Area of Science:
- Pediatric critical care medicine
- Thoracic surgery
- Interventional radiology
Background:
- Pleural effusions and pneumothorax are common in pediatric patients.
- Effective management of pleural air and fluid is crucial for patient recovery.
- Percutaneous pigtail catheters offer a minimally invasive approach for thoracic drainage.
Purpose of the Study:
- To evaluate the efficacy of percutaneous pigtail catheters in pediatric patients with pleural air or fluid.
- To identify factors influencing catheter success rates.
- To assess the complication profile associated with pigtail catheter use in children.
Main Methods:
- A retrospective case series design was employed.
- Data were collected from pediatric intensive care unit admissions between January 1996 and August 1997.
- Chart review of 91 pediatric patients who underwent 133 pigtail catheter placements.
Main Results:
- Pigtail catheters demonstrated high efficacy in draining serous (96%) and chylous (100%) effusions.
- Drainage efficacy for hemothorax was 81%, and pneumothorax evacuation was achieved in 75% of cases.
- Complications from placement (5%) were uncommon but serious; complications from use (20%) were more frequent but less severe, particularly in smaller infants (<5 kg).
Conclusions:
- Percutaneous pigtail catheters are highly effective for pleural serous and chylous effusions in children.
- Catheter efficacy is reduced for empyema and hemothorax, and moderate for pneumothorax.
- While placement complications are rare, careful monitoring is essential to minimize complications during catheter use, especially in very small infants.
Objective:
To describe the efficacy of percutaneous pigtail catheters in evacuating pleural air or fluid in pediatric patients.
Design:
A case series of children with percutaneous pigtail catheters placed in the pediatric ICU between January 1996 and August 1997.
Setting:
Urban pediatric teaching hospital in Seattle, WA.
Methods:
A retrospective chart review.
Results:
Ninety-one children required 133 chest catheters. Most patients were infants with congenital heart disease (80%). One hundred thirteen of the catheters (85%) were placed for pleural effusion, with 20 tubes (15%) placed for pneumothorax. Efficacy of drainage of pleural fluid was significantly greater in serous (96%) and chylous (100%) effusions compared with empyema (0%) or hemothorax (81%). Evacuation of pneumothorax was achieved by a pigtail catheter in 75% of patients. Resolution of pleural air or pneumothorax was significantly greater in patients < 10 kg compared with larger children. Complications due to placement of the pigtail catheters included hemothorax (n=3, 2%), pneumothorax (n=3, 2%), and hepatic perforation (n= 1, 1%). There were also complications arising from the use of the catheters, including failure to drain, dislodgment, kinking, loss of liquid ventilation fluid, empyema, and disconnection in 27 of 133 catheters (20%). Significantly more complications during catheter use occurred in patients <5 kg than in larger children.
Conclusions:
Percutaneous pigtail catheters are highly effective in drainage of pleural serous and chylous effusions, somewhat less efficacious in drainage of hemothorax or pneumothorax, and least efficacious in drainage of empyema. Infants and smaller children had higher rates of resolution of pleural air and fluid from placement of a pigtail catheter than larger children. Complications from catheter placement were uncommon (5%) but serious, whereas complications associated with continued use of the catheters were more common (20%) but less grave. Strict attention to anatomic landmarks and close monitoring may reduce the number of complications.
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