The Best in FOAM Education

How To Do It: Thoracic Pigtails

February 21, 2020

A 31 year old male with a history of leiomyoscarcoma and metastasis to the lungs presents to the emergency department for 2 days of shortness of breath. He had been on chemo up until last month when he decided to stop all medical interventions. He denies fevers, chills, chest pain, nausea, vomiting, diarrhea, constipation, and changes in stool habits.

 

Physical Exam and Pertinent Labs

  • T 98.6, HR 86, BP 118/73, RR 26, SaO2 94%

  • General - Awake, alert, oriented x4

  • CV - Regular rate and rhythm, No jugular venous distension

  • Pulm - Decreased breath sounds on the right with dullness to percussion

  • CBC and Chem-8 WNL

  • Coags WNL

 

Imaging

  • Bedside US demonstrates a right sided pleural effusion

  • CXR/CT Chest demonstrated right sided pleural effusion.

 

A 14 french pigtail catheter was placed with successful drainage of the pleural effusion and improvement of respiratory rate/O2sat.

 

 

Take Away #1:

Optimal candidates for pigtail catheters are those with thin, free flowing fluids such as air or new pleural effusions

 

Take Away #2:

Contraindications: Unstable patients, empyema, traumatic (hemothorax), loculated pleural effusion (unlikely to successfully drain).

 

Caution when using pigtails on those with emphysema out of concern for entering a peripheral bleb creating a broncho-pleural fistula.

 

Take Away #3:

There is limited data, but the literature demonstrates no significant differences in mechanical ventilations use, number of tube days, or the number of ICU days when comparing chest tubes to pigtails

 

Take Away #4:

Triangle of safety lives between the latissimus dorsi, pectoralis major, and the 5th intercostal. Insert here to avoid accidentally entering the ventricles or liver.

 

References:

 

Edited by Bassam Zahid

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