Tube selection
Tube selection for non-emergency pleural drains should be made in consultation with the admitting medical officer.
Types of Pleural Drains
Small Bore Pleural Catheters
Indications: spontaneous pneumothorax: free flowing pleural effusions or empyema11-13.
Small bore catheters may include straight catheters or pigtail catheters with or without an indwelling tension mechanism.
The procedure is less painful for the patient but there is increased risk of tube blockage and failed drainage.
Large Bore Intercostal Catheter (ICC) >20Fr
Indications: haemothorax, acute trauma, open thoracostomy, post cardiothoracic, oesophageal or spinal surgery.
Exclusion
Indwelling Pleural Catheters or Tunnelled Catheters are a specialised procedure that is performed in dedicated units and therefore considered outside the scope of this document.
Pleural Pigtail Catheters have a variety of locking mechanisms.
Facilities should ensure that information related to type of pigtail drain and locking mechanism in use is available for relevant clinicians.
Figure 3: Large Bore Intercostal Catheter and Pleural Pigtail Catheter
Figure 4: Pigtail drain with thread formation of pigtail shape
Table 1 Tube Selection in adults
| Pleural Drain Insertion Technique | Haemothorax | Pleural Effusion | Pneumothorax | Pyothorax Empyema |
|---|---|---|---|---|
| Blunt Dissection Large Bore | Size >20 Fr | Size >20 Fr | Size 24 Fr traumatic only | Size >20 Fr |
| Seldinger Technique Small Bore | Not applicable | Fine bore tube for low viscosity effusions only | 8-14 Fr or Small bore only | Size ≥14 Fr |