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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
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Publication History

Publication Date:
22 March 2011 (online)

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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.

KEYWORDS

Thoracostomy - tube thoracostomy - pleural drain - pleurodesis

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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 6 Ga H. Textbook of Medical Physiology. 10th ed. Philadelphia: W.B. Saunders; 2000
    Google Scholar
  • 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
    Google Scholar
  • 8 Noppen M. Normal volume and cellular contents of pleural fluid.  Paediatr Respir Rev. 2004;  5 (Suppl A) S201-S203
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 11 Roberts J, Hedges JR.. Clinical Procedures in Emergency Medicine. 5th ed. Philadephia: Elsevier Saunders; 2009
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 13 Mason R J, Courtney Broaddus V, Martin T, King Jr T. Murray and Nadel's Textbook of Respiratory Medicine. Philadephia: Elsevier Saunders; 2010
    Google Scholar
  • 14 Bartlett J GFS, Finegold S M. Anaerobic infections of the lung and pleural space.  Am Rev Respir Dis. 1974;  110 (1) 56-77
    PubMedGoogle Scholar
  • 15 Townsend C. Sabiston Textbook of Surgery. Philadelphia: Elsevier Saunders; 2007
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 23 Tremblay A, Michaud G. Single-center experience with 250 tunnelled pleural catheter insertions for malignant pleural effusion.  Chest. 2006;  129 (2) 362-368
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 29 Gross S B. Current challenges, concepts, and controversies in chest tube management.  AACN Clin Issues Crit Care Nurs. 1993;  4 (2) 260-275
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 39 Musani A I. Treatment options for malignant pleural effusion.  Curr Opin Pulm Med. 2009;  15 (4) 380-387
    CrossrefPubMedGoogle Scholar
  • 40 Rodriguez-Panadero F, Antony V B. Pleurodesis: state of the art.  Eur Respir J. 1997;  10 (7) 1648-1654
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar

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