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An intrapleural chest tube is also known as a Bülau drain or an intercostal catheter (ICC), and can either be a thin, flexible silicone tube (known as a "pigtail" drain), or a larger, semi-rigid, fenestrated plastic tube, which often involves a flutter valve or underwater seal.
Pleurodesis fails in as many as 30% of cases. An alternative is to place a PleurX Pleural Catheter or Aspira Drainage Catheter. This is a 15Fr chest tube with a one-way valve. Each day the patient or caregivers connect it to a simple vacuum tube and remove from 600 to 1000 mL of fluid, and can be repeated daily. When not in use, the tube is capped.
Alternatively, tunneled pleural catheters (TPCs) may be placed in an outpatient setting and often result in auto-pleurodesis, whereby portable vacuum bottles are used to evacuate the pleural fluid. Routine evacuation keeps the pleura together, resulting in physical agitation by the catheter, which slowly causes the pleura to scar together.
This has led to the development of tunneled pleural catheters (e.g., Pleurx Catheters), which allow outpatient treatment of effusions. If an infection due to the catheter occurs, antibiotics are given and the catheter is generally left in. [16]
Thoracentesis / ˌ θ ɔː r ə s ɪ n ˈ t iː s ɪ s /, also known as thoracocentesis (from Greek θώραξ (thōrax, GEN thōrakos) 'chest, thorax' and κέντησις (kentēsis) 'pricking, puncture'), pleural tap, needle thoracostomy, or needle decompression (often used term), is an invasive medical procedure to remove fluid or air from the pleural space for diagnostic or therapeutic ...
Pigtail catheter is a non-selective catheter with multiple side holes that can deliver large volumes of contrast into a blood vessel for imaging purposes. [29] Cobra catheter is a selective catheter used to catheterise downgoing vessels in the abdomen. Cobra catheters move forward by pushing and are removed by pulling. [30]
In the first case, small-bore catheters not suitable for the drainage of blood (e.g. hemopericard) are used. Pericardial drains are mostly used with the help of gravity. As a pericardial drain is placed surgically, a largo bore drain is used with a decreased probability of clogging.
The condition can be treated by mechanically removing the fluid via thoracocentesis (also known as a "pleural tap") with a pigtail catheter, a chest tube, or a thoracoscopic procedure. Infected pleural effusion can lead to pleural empyema , which can create significant adhesion and fibrosis that require division and decortication .
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