PURPOSE: Drainage of pleural effusions and pneumothoraces by placement of large bore chest tubes has been a conventional method of treatment. Triple-lumen catheters, which are widely used for intravenous access, are an alternative approach of draining. The purpose of this study is to analyze the feasibility and safety of triple-lumen catheters for the management of pleural effusions and pneumothoraces.
METHODS: Triple-lumen catheters were placed in twenty consecutive patients. Triple-lumen catheters (Edward Lifesciences) with a width of 7 French a length of 20 centimeters with exit lumens at 0 mm, 20 mm and 50 mm were used. The catheter was placed into the pleural space over a guide wire at the second intercostal space in the mid-clavicular line using the Seldinger technique. After the air was aspirated from all the 3 ports by a 60 ml syringe, the catheter was removed and occlusive dressing applied. Placement of the triple-lumen catheter for pleural effusion was performed with ultrasound guidance, real time, at the bedside. One of the ports was connected to dry suction chest drain by a multipurpose tubing adapter while the other ports were clamped. The catheter was not used for hemothorax or empyema.
RESULTS: Of the 20 consecutive patients, in whom these catheters were placed, 3 had pneumothorax and 17 had pleural effusion. Doxycycline pleurodesis was performed in 3 of the 17 patients. Drainage of the pleural effusions and pneumothoraces was successful in all patients. None of the patients had complications such as pneumothorax, hemothorax or infection. This approach has the advantage of minimizing risk of lung injury and pain.
CONCLUSION: Large bore chest tubes are associated with subcutaneous emphysema, increased pain and risk of bleeding. Triple-lumen catheters are minimally invasive, safe and effective. Medical residents are more comfortable due to prior use of triple-lumen catheters for central venous access.
CLINICAL IMPLICATIONS: The triple-lumen catheter is an effective method for drainage. Advantages over the large bore chest tube include decreased side effects, cost and hospitalization time.
DISCLOSURE: Lalit Kanaparthi, No Financial Disclosure Information; No Product/Research Disclosure Information