Placement of a Pigtail Catheter Intercostal Drain

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Dr. Sacchetti reviews the insertion of a pigtail chest tube.


EM:RAP 2022 October Pediatric Pearls: Pneumothorax Smackdown

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Paul S. -

Really nice, clear video and easy to follow instructions. I only have one comment; for most spontaneous pneumos, I've been simply aspirating them, not leaving any tube in there, observe in the ED for a few hours with a repeat CXR, discharge and have the patient have follow up CXR's as an outpatient.
Any comment about that approach?

Andrea W. -

Is all this equipment from a commercially available kit? If so, what kit are you using? If you are assembling all of the pieces individually, what are you using?

Evan P. -

The Wayne Pneumothorax kit is the one we use at my hospital. It has everything pictured on his set-up.

Christopher F. -

Caution when aspirating pneumothorax that has been ongoing for some time--my case 10 days. Acutely expanding collapsed lung can cause significant V/Q mismatch and problems.

SD -

Instead of manual inspiration, what about just utilizing suction before allowing them to sit up?

Burner -

That seems like a good question. Have you tried this?

Alonso M. -

This! I was thinking the same thing... any problems if you connect to suction?

Burner -

Great video. I placed one in a vented covid patient, and it flopped down over the diaphragm. Now I understand why and how to prevent that.

Jonathan C., D.O. -

I have questions about the pig tail catheter chest tube video:

1. What is the different between aspirating with a syringe at the end of the procedure vs just hooking the pigtail up to a pleurovac. It seems like the pleurovac suction would do the same thing and quicker?

2. Do you have any idea why the pigtail was developed the way it was over simply having a small french straight chest tube. What I am wondering, is what the pig tail actually does better than a small chest tube? Does the pig tail form better around the lung tissue?

Michael O. -

Our hospital carries the Wayne kit that has a flutter valve. We have had patients that have pleural fluid escape through the flutter valve. Any suggestions on a commercially available container for fluid to drain into?

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