Abstract
Thoracic ultrasound is a powerful diagnostic imaging technique for pleural space disorders. In addition to visualising pleural effusion, thoracic ultrasound also helps clinicians to identify the best puncture site and to guide the drainage insertion procedure. Thoracic ultrasound is essential during these invasive manoeuvres to increase safety and decrease potential life-threatening complications. This paper provides a technical description of pigtail-type drainage insertion using thoracic ultrasound, paying particular attention to indications, contraindications, ultrasound guidance, preparation/equipment, procedure and complications.
Highlights
Percutaneous pleural drainage is the third most commonly performed procedure in the intensive care unit (ICU) after vascular catheterisation and tracheal intubation [1–3]
Forty-one percent of patients admitted to the ICU have pleural effusion at the time of admission, while 21% will develop it during hospitalisation [4]
In “direct needle guidance” ultrasound is used in real-time to guide the pleural puncture; some operators prefer to perform needle insertion under real-time ultrasound guidance even though this approach is more technically challenging [29]
Summary
Percutaneous pleural drainage is the third most commonly performed procedure in the intensive care unit (ICU) after vascular catheterisation and tracheal intubation [1–3]. The use of bedside ultrasound (US) leads to an improvement in the diagnosis [7], and allows the detection of the best puncture site and the fluid quantification of PLEFF [8, 9]. Identification of puncture site Pigtail insertion should be carried out in the safety triangle, almost always at the posterior axillary line if aiming for effusion [11], and performed under image guidance [11, 17]. To obtain separation (Sep), the operator has to measure the maximal vertical distance between the parietal and visceral pleura in end-expiration at the lung base, in supine patient with trunk elevation of 10–15°. In “direct needle guidance” ultrasound is used in real-time to guide the pleural puncture; some operators prefer to perform needle insertion under real-time ultrasound guidance even though this approach is more technically challenging [29].
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