Category: Procedures

Pigtail Catheter vs Large Bore Chest Tube for Pneumothorax

Written by Jessica DiPeri, MD
This post first appeared on REBEL EM

Background: Pneumothorax management is a common clinical condition in the emergency department (ED) occurring in patients of varying ages and caused by multiple etiologies, including spontaneous, traumatic, and iatrogenic pneumothorax. Regardless of the cause, a thoracostomy is often required for treatment (Currie 2007). Traditionally, all pneumothoraces were treated with large bore chest tubes (LBCT) defined as any tube > 14 F. The benefits of a small bore catheter (ie a pigtail catheter (PC) include less trauma to the chest wall and less patient pain. Additionally, small-bore catheter placement is performed via the Seldinger technique;’ a skill possessed by all Emergency Physicians (Bauman 2018). The decision to use a LBCT vs. a PC in the treatment of pneumothorax has been widely studied over the last decade, yet clinical practice still varies.

Article: Chang, Su-Huan et al. “A Systematic Review and Meta-Analysis Comparing Pigtail Catheter and Chest Tube as the Initial Treatment for Pneumothorax.” Chest vol. 153,5 (2018): 1201-1212. PMID: 29452099 Prospero: CRD42017078481

Clinical Question: Is a pigtail catheter (PC) more effective than a large bore chest tube (LBCT) for treating pneumothorax?

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Ultrasound-Guided Lumbar Puncture

A 68-year old obese female with a past medical history of osteoarthritis, diabetes, and cervical spinal fusion presents to the Emergency Department (ED) complaining of generalized weakness for the last week. In addition, she reports that she had cold symptoms approximately one week before the onset of her weakness. Upon further questioning, the patient also reports numbness and tingling of her bilateral lower extremities. The review of systems is otherwise negative.

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TLC: Triple Lumen Complications

Placing central venous cathethers, whether under ultrasound guidance or based off of your landmarks can be difficult and still prone to many complications. With the increased use and now standard of care for placing central lines with ultrasound guidance you would think we are immune to the “catastrophic” complication of an inadvertent arterial cannulation. But does ultrasound make us infalliable? Are there other methods that we can use to confirm venous placement of these large catheters?

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