Semin intervent Radiol 2011; 28(1): 039-047
DOI: 10.1055/s-0031-1273939
© Thieme Medical Publishers

Tube Thoracostomy: A Review for the Interventional Radiologist

Jeremy R. Hogg1 , Michael Caccavale1 , Benjamin Gillen1 , Gavin McKenzie1 , Jay Vlaminck1 , Chad J. Fleming2 , Andrew Stockland2 , Jeremy L. Friese2
  • 1Department of Radiology, Mayo Clinic, Rochester, Minnesota
  • 2Division of Interventional Radiology, Mayo Clinic, Rochester, Minnesota
Further Information

Publication History

Publication Date:
22 March 2011 (online)

ABSTRACT

Small-caliber tube thoracostomy is a valuable treatment for various pathologic conditions of the pleural space. Smaller caliber tubes placed under image guidance are becoming increasingly useful in numerous situations, are less painful than larger surgical tubes, and provide more accurate positioning when compared with tubes placed without image guidance. Basic anatomy and physiology of the pleural space, indications, and contraindications of small caliber tube thoracostomy, techniques for image-guided placement, complications and management of tube thoracostomy, and fundamental principles of pleurodesis are discussed in this review.

REFERENCES

  • 1 Rahman N M, Maskell N A, Davies C W et al.. The relationship between chest tube size and clinical outcome in pleural infection.  Chest. 2010;  137 (3) 536-543
  • 2 Rivera L, O'Reilly E B, Sise M J et al.. Small catheter tube thoracostomy: effective in managing chest trauma in stable patients.  J Trauma. 2009;  66 (2) 393-399
  • 3 Protic A, Barkovic I, Bralic M, Cicvaric T, Stifter S, Sustic A. Targeted wire-guided chest tube placement: a cadaver study.  Eur J Emerg Med. 2010;  17 (3) 146-149
  • 4 Albertine K H, Wiener-Kronish J P, Bastacky J, Staub N C. No evidence for mesothelial cell contact across the costal pleural space of sheep.  J Appl Physiol. 1991;  70 (1) 123-134
  • 5 Wang N S. The preformed stomas connecting the pleural cavity and the lymphatics in the parietal pleura.  Am Rev Respir Dis. 1975;  111 (1) 12-20
  • 6 Ga H. Textbook of Medical Physiology. 10th ed. Philadelphia: W.B. Saunders; 2000
  • 7 George R B, Light R W, Mathay M A, Mathay R A. Chest Medicine: Essentials of Pulmonary and Critical Care Medicine. 5th ed. Philadelphia: Lippincott, Williams, and Wilkins; 2006
  • 8 Noppen M. Normal volume and cellular contents of pleural fluid.  Paediatr Respir Rev. 2004;  5 (Suppl A) S201-S203
  • 9 Baumann MHSC, Strange C, Heffner J E AACP Pneumothorax Consensus Group et al. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement.  Chest. 2001;  119 (2) 590-602
  • 10 Doelken PAR, Abreu R, Sahn S A, Mayo P H. Effect of thoracentesis on respiratory mechanics and gas exchange in the patient receiving mechanical ventilation.  Chest. 2006;  130 (5) 1354-1361
  • 11 Roberts J, Hedges JR.. Clinical Procedures in Emergency Medicine. 5th ed. Philadephia: Elsevier Saunders; 2009
  • 12 Dev S PNB, Nascimiento Jr B, Simone C, Chien V. Videos in clinical medicine. Chest-tube insertion.  N Engl J Med. 2007;  357 (15) e15
  • 13 Mason R J, Courtney Broaddus V, Martin T, King Jr T. Murray and Nadel's Textbook of Respiratory Medicine. Philadephia: Elsevier Saunders; 2010
  • 14 Bartlett J GFS, Finegold S M. Anaerobic infections of the lung and pleural space.  Am Rev Respir Dis. 1974;  110 (1) 56-77
  • 15 Townsend C. Sabiston Textbook of Surgery. Philadelphia: Elsevier Saunders; 2007
  • 16 Gammie J S, Banks M C, Fuhrman C R et al.. The pigtail catheter for pleural drainage: a less invasive alternative to tube thoracostomy.  JSLS. 1999;  3 (1) 57-61
  • 17 Tsai W K, Chen W, Lee J C et al.. Pigtail catheters vs large-bore chest tubes for management of secondary spontaneous pneumothoraces in adults.  Am J Emerg Med. 2006;  24 (7) 795-800
  • 18 Liu Y H, Lin Y C, Liang S J et al.. Ultrasound-guided pigtail catheters for drainage of various pleural diseases.  Am J Emerg Med. 2010;  28 (8) 915-921
  • 19 Warren W H, Kalimi R, Khodadadian L M, Kim A W. Management of malignant pleural effusions using the Pleur(x) catheter.  Ann Thorac Surg. 2008;  85 (3) 1049-1055
  • 20 Pollak J S, Burdge C M, Rosenblatt M, Houston J P, Hwu W J, Murren J. Treatment of malignant pleural effusions with tunneled long-term drainage catheters.  J Vasc Interv Radiol. 2001;  12 (2) 201-208
  • 21 Meter M V. Efficacy and safety of tunneled pleural catheters in adults with malignant pleural effusions: a systematic review.  J Gen Intern Med. 2011;  26 (1) 70-76
  • 22 Roberts J S, Bratton S L, Brogan T V. Efficacy and complications of percutaneous pigtail catheters for thoracostomy in pediatric patients.  Chest. 1998;  114 (4) 1116-1121
  • 23 Tremblay A, Michaud G. Single-center experience with 250 tunnelled pleural catheter insertions for malignant pleural effusion.  Chest. 2006;  129 (2) 362-368
  • 24 Sanabria A, Valdivieso E, Gomez G, Echeverry G. Prophylactic antibiotics in chest trauma: a meta-analysis of high-quality studies.  World J Surg. 2006;  30 (10) 1843-1847
  • 25 Baldt M M, Bankier A A, Germann P S, Pöschl G P, Skrbensky G T, Herold C J. Complications after emergency tube thoracostomy: assessment with CT.  Radiology. 1995;  195 (2) 539-543
  • 26 Durai R, Hoque H, Davies T W. Managing a chest tube and drainage system.  AORN J. 2010;  91 (2) 275-280 quiz 281-283
  • 27 Baumann M H. What size chest tube? What drainage system is ideal? And other chest tube management questions.  Curr Opin Pulm Med. 2003;  9 (4) 276-281
  • 28 Gordon P A, Norton J M, Merrell R. Refining chest tube management: analysis of the state of practice.  Dimens Crit Care Nurs. 1995;  14 (1) 6-12 quiz 13
  • 29 Gross S B. Current challenges, concepts, and controversies in chest tube management.  AACN Clin Issues Crit Care Nurs. 1993;  4 (2) 260-275
  • 30 Gervais D A, Levis D A, Hahn P F, Uppot R N, Arellano R S, Mueller P R. Adjunctive intrapleural tissue plasminogen activator administered via chest tubes placed with imaging guidance: effectiveness and risk for hemorrhage.  Radiology. 2008;  246 (3) 956-963
  • 31 Levinson G M, Pennington D W. Intrapleural fibrinolytics combined with image-guided chest tube drainage for pleural infection.  Mayo Clin Proc. 2007;  82 (4) 407-413
  • 32 Thommi G, Nair C K, Aronow W S, Shehan C, Meyers P, McLeay M. Efficacy and safety of intrapleural instillation of alteplase in the management of complicated pleural effusion or empyema.  Am J Ther. 2007;  14 (4) 341-345
  • 33 Zuckerman D A, Reed M F, Howington J A, Moulton J S. Efficacy of intrapleural tissue-type plasminogen activator in the treatment of loculated parapneumonic effusions.  J Vasc Interv Radiol. 2009;  20 (8) 1066-1069
  • 34 Adrales G, Huynh T, Broering B et al.. A thoracostomy tube guideline improves management efficiency in trauma patients.  J Trauma. 2002;  52 (2) 210-214 discussion 214-216
  • 35 Heffner J E, Klein J S. Recent advances in the diagnosis and management of malignant pleural effusions.  Mayo Clin Proc. 2008;  83 (2) 235-250
  • 36 Lombardi G, Zustovich F, Nicoletto M O, Donach M, Artioli G, Pastorelli D. Diagnosis and treatment of malignant pleural effusion: a systematic literature review and new approaches.  Am J Clin Oncol. 2010;  33 (4) 420-423
  • 37 Stefani A, Natali P, Casali C, Morandi U. Talc poudrage versus talc slurry in the treatment of malignant pleural effusion. A prospective comparative study.  Eur J Cardiothorac Surg. 2006;  30 (6) 827-832
  • 38 Steger V, Mika U, Toomes H et al.. Who gains most? A 10-year experience with 611 thoracoscopic talc pleurodeses.  Ann Thorac Surg. 2007;  83 (6) 1940-1945
  • 39 Musani A I. Treatment options for malignant pleural effusion.  Curr Opin Pulm Med. 2009;  15 (4) 380-387
  • 40 Rodriguez-Panadero F, Antony V B. Pleurodesis: state of the art.  Eur Respir J. 1997;  10 (7) 1648-1654
  • 41 Balassoulis G, Sichletidis L, Spyratos D et al.. Efficacy and safety of erythromycin as sclerosing agent in patients with recurrent malignant pleural effusion.  Am J Clin Oncol. 2008;  31 (4) 384-389
  • 42 Davies H E, Lee Y CG, Davies R JO. Pleurodesis for malignant pleural effusion: talc, toxicity and where next?.  Thorax. 2008;  63 (7) 572-574
  • 43 Hunt I, Barber B, Southon R, Treasure T. Is talc pleurodesis safe for young patients following primary spontaneous pneumothorax?.  Interact Cardiovasc Thorac Surg. 2007;  6 (1) 117-120
  • 44 Györik S, Erni S, Studler U, Hodek-Wuerz R, Tamm M, Chhajed P N. Long-term follow-up of thoracoscopic talc pleurodesis for primary spontaneous pneumothorax.  Eur Respir J. 2007;  29 (4) 757-760
  • 45 Lee P, Colt H G. A spray catheter technique for pleural anesthesia: a novel method for pain control before talc poudrage.  Anesth Analg. 2007;  104 (1) 198-200

Jeremy L FrieseM.D. M.B.A. 

Assistant Professor of Radiology, Division of Vascular and Interventional Radiology, Mayo Clinic

200 First Street SW, Rochester, MN 55905

Email: friese.jeremy@mayo.edu