Chest drainage: clinical evaluation of a Seldinger drainage kit

Abstract

Chest drain insertion is required in the intensive care unit and high dependency care setting. Catheter insertion may be required for pneumothorax both spontaneous and iatrogenic, for the drainage of pleural effusions, or for the drainage of empyemas. Large bore catheters are difficult to insert and may be associated with adverse complications.1 A new catheter system developed by SIMS Portex has been introduced to insert a small catheter into the chest. This has been developed to minimise the complications associated with conventional tube drainage. The catheter is inserted over a guide wire with dilation of the chest wall. The catheter is 285 mm long has two lateral eyes and an open end. Data are presented on 20 small-bore (12 French gauge) Seldinger chest drainage catheters. Three were placed in children two with spontaneous pneumothorax (10 and 15 yr) and one with parapneumonic effusion (7 yr). Seventeen further catheters were placed in adults: seven for pneumothoraces and 10 for effusions. Four catheters were inserted as emergencies for deteriorating respiratory function. These patients were all being ventilated on the intensive care unit. All catheters were inserted with ease into the pleural space. Ultrasound guidance for effusions to assess the presence of loculations, or X-ray diagnosis of the pneumothorax prior to catheter insertion was used for all cases. One catheter system needed to be removed due to apparent blockage. All the other catheters performed well draining an average of 2.1 litre of fluid for the effusions and reinflating the lung in all the patients with pneumothoraces. Small-bore catheter chest drainage is simple and effective.2 The use of a guide wire system has advantages over conventional open chest drain insertion. There is less possibility of damage to the underlying lung tissue, less probability of the introduction of air into the thoracic cavity and greater operator confidence. The catheter is more comfortable, easier to insert, and effective in clinical use. This study confirms that small catheters are effective for emergency and non-emergency pneumothorax and effusion drainage.3