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?