Small bore intercostal catheters are as efficient as large bore intercostal tubes with better patient tolerance

Abstract

Background: Pleural diseases are one of the most common clinical problems encountered worldwide. Large-bore (LB) intercostal tube (ICT; e.g. >20 F) drainage has been the standard of care in the management of pleural diseases for several decades. More recently small-bore (SB) intercostal catheters (ICC; e.g. 10-14 F) have gained acceptance as an alternative to LB ICTs.1 However, the choice of the ICT/ICC size in the management of patients presenting acutely with pleural effusion or pneumothorax remains controversial. Aims: The purpose of this study was to evaluate our current practice and to access the efficacy of SB ICCs (10-14 F) versus LB ICTs (>20 F) in the management of pleural diseases. Settings: Tertiary teaching hospital. Design: Prospective non-randomised audit. Methods and Material: A total of 52 patients (42 males) with a mean age of 55 ± 23 years undergoing pleural intervention were included in the analysis. Initial treatment success was defined as complete resolution of effusion or pneumothorax without ICT/ICC kinking, obstruction, displacement or needing second intervention such as placement of a second ICT/ICC or surgery. 27 patients underwent SB ICC (mean age 63 ± 19 years) and 25 underwent LB ICT (mean age 46 ± 24 years). Results: A trend towards inserting SB ICCs in patients with primary pleural effusion and LB ICT drains in patients presenting with pneumothorax was noted. Success rate of SB ICC and LB ICTs was 74% and 76% respectively. Drain failure or second intervention to achieve successful outcome in patients with SB ICCs was predominantly related to loculated effusion and persistent air leak secondary to pneumothorax while drain failure in patients with LB ICTs was predominantly related to partial or complete dislodgement of the chest drain; particularly during inter-hospital transfer or persistent air leak. In both groups, no deaths or major complications directly related to the procedure were observed. The ICC dwell time was lesser in SB ICC (6 ± 4 days) versus LB ICT (8 ± 6 days). SB ICCs were associated with less pain and seem to be tolerated better by the patients. Conclusions: Our study suggests that SB ICCs are as efficient as LB ICTs with better patient tolerance and less dwell time. The results are similar to previous studies which have reported similar success, complications rates, dwell time and patient tolerance.2,3.