Evacuation of traumatic hemothorax (HTx) is typically accomplished with large-bore (28–40 Fr) chest tubes, often resulting in patient discomfort. Management of HTx with smaller (14 Fr) pigtail catheters has not been widely adopted because of concerns about tube occlusion and blood evacuation rates. We compared pigtail catheters with chest tubes for the drainage of acute HTx in a swine model.
Six Yorkshire cross-bred swine (44–54 kg) were anesthetized, instrumented, and mechanically ventilated. A 32 Fr chest tube was placed in one randomly assigned hemithorax; a 14 Fr pigtail catheter was placed in the other. Each was connected to a chest drainage system at −20 cm H2O suction and clamped. Over 15 minutes, 1,500 mL of arterial blood was withdrawn via femoral artery catheters. Seven hundred fifty milliliters of the withdrawn blood was instilled into each pleural space, and fluid resuscitation with colloid was initiated. The chest drains were then unclamped. Output from each drain was measured every minute for 5 minutes and then every 5 minutes for 40 minutes. The swine were euthanized, and thoracotomies were performed to quantify the volume of blood remaining in each pleural space and to examine the position of each tube.
Blood drainage was more rapid from the chest tube during the first 3 minutes compared with the pigtail catheter (348 ± 109 mL/min vs. 176 ± 53 mL/min), but this difference was not statistically significant (p = 0.19). Thereafter, the rates of drainage between the two tubes were not substantially different. The chest tube drained a higher total percentage of the blood from the chest (87.3% vs. 70.3%), but this difference did not reach statistical significance (p = 0.21).
We found no statistically significant difference in the volume of blood drained by a 14 Fr pigtail catheter compared with a 32 Fr chest tube.
From the Department of Surgery (R.M.R., S.A.Z., L.P.N., R.A.H., J.M.G., D.V.S.), UC Davis Medical Center, Sacramento; and Department of Surgery (S.A.Z., L.P.N., R.A.H.), and Clinical Investigation Facility (J.K.G.), David Grant USAF Medical Center, Travis Air Force Base, California.
Submitted: January 16, 2015, Revised: March 27, 2015, Accepted: April 8, 2015, Published online: August 28, 2015.
This study was presented at the 45th Annual Meeting of the Western Trauma Association, March 1–6, 2015, in Telluride, Colorado.
The animals involved in this study were procured, maintained, and used in accordance with the Laboratory Animal Welfare Act of 1966, as amended, and NIH 80–23, Guide for the Care and Use of Laboratory Animals, National Research Council.
The views expressed in this material are those of the authors and do not reflect the official policy or position of the US Government, the Department of Defense, the Department of the Air Force, or the University of California Davis.
The work reported herein was performed under United States Air Force Surgeon General approved Clinical Investigation No. FDG20140037A.
The Cook Medical, Inc. Wayne Pneumothorax pigtail catheter is not FDA approved for use in drainage of hemothoraces.
Address for reprints: David V. Shatz, MD, Division of Trauma and Surgical Critical Care, Department of Surgery, UC Davis Medical Center 2315 Stockton Blvd, Rm 4209, Sacramento, CA 95817; email: email@example.com.