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Consensus Guideline

Pleural Drains in Adults

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.


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.

Large Bore Intercostal Catheter and Pleural Pigtail Catheter
Figure 3: Large Bore Intercostal Catheter and Pleural Pigtail Catheter

Drain tube showing thread used to create a loop at the end
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


Small bore only

Size ≥14 Fr