14 French pigtail catheters placed by surgeons to drain blood on trauma patients: Is 14-Fr too small?

Narong Kulvatunyou, Bellal Joseph, Randall S. Friese, Donald Green, Lynn Gries, Terence OKeeffe, Andy L. Tang, Julie L. Wynne, Peter Rhee

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

BACKGROUND: Small 14F pigtail catheters (PCs) have been shown to drain air quite well in patients with traumatic pneumothorax (PTX). But their effectiveness in draining blood in patients with traumatic hemothorax (HTX) or hemopneumothorax (HPTX) is unknown. We hypothesized that 14F PCs can drain blood as well as large-bore 32F to 40F chest tubes. We herein report our early case series experience with PCs in the management of traumatic HTX and HPTX. METHODS: We prospectively collected data on all bedside-inserted PCs in patients with traumatic HTX or HPTX during a 30-month period (July 2009 through December 2011) at our Level I trauma center. We then compared our PC prospective data with our trauma registry-derived retrospective chest tube data (January 2008 through December 2010) at our center. Our primary outcome of interest was the initial drainage output. Our secondary outcomes were tube duration, insertion-related complications, and failure rate. For our statistical analysis, we used the unpaired Student's t-test, χ test, and Wilcoxon rank-sum test; we defined significance by a value of p < 0.05. RESULTS: A total of 36 patients received PCs, and 191 received chest tubes. Our PC group had a higher rate of blunt mechanism injuries than our chest tube group did (83 vs. 62%; p = 0.01). The mean initial output was similar between our PC group (560 ± 81 mL) and our chest tube group (426 ± 37 mL) (p = 0.13). In the PC group, the tube was inserted later (median, Day 1; interquartile range, Days 0-3) than the tube inserted in our chest tube group (median, Day 0; interquartile range, Days 0-0) (p < 0.001). Tube duration, rate of insertion-related complications, and failure rate were all similar. CONCLUSION: In our early experience, 14F PCs seemed to drain blood as well as large-bore chest tubes based on initial drainage output and other outcomes studied. In this early phase, we were being selective in inserting PCs in only stable blunt trauma patients, and PCs were inserted at a later day from the time of the initial evaluation. In the future, we will need a larger sample size and possibly a well-designed prospective study. LEVEL OF EVIDENCE: Therapeutic study, level V.

Original languageEnglish (US)
Pages (from-to)1423-1427
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume73
Issue number6
DOIs
StatePublished - Dec 1 2012
Externally publishedYes

Fingerprint

Catheters
Chest Tubes
Wounds and Injuries
Hemopneumothorax
Hemothorax
Nonparametric Statistics
Surgeons
Drainage
Nonpenetrating Wounds
Trauma Centers
Pneumothorax
Sample Size
Registries
Air
Prospective Studies
Students

Keywords

  • Chest tube
  • Chest wall trauma
  • hemothorax
  • pigtail catheter

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

14 French pigtail catheters placed by surgeons to drain blood on trauma patients : Is 14-Fr too small? / Kulvatunyou, Narong; Joseph, Bellal; Friese, Randall S.; Green, Donald; Gries, Lynn; OKeeffe, Terence; Tang, Andy L.; Wynne, Julie L.; Rhee, Peter.

In: Journal of Trauma and Acute Care Surgery, Vol. 73, No. 6, 01.12.2012, p. 1423-1427.

Research output: Contribution to journalArticle

Kulvatunyou, N, Joseph, B, Friese, RS, Green, D, Gries, L, OKeeffe, T, Tang, AL, Wynne, JL & Rhee, P 2012, '14 French pigtail catheters placed by surgeons to drain blood on trauma patients: Is 14-Fr too small?', Journal of Trauma and Acute Care Surgery, vol. 73, no. 6, pp. 1423-1427. https://doi.org/10.1097/TA.0b013e318271c1c7
Kulvatunyou, Narong ; Joseph, Bellal ; Friese, Randall S. ; Green, Donald ; Gries, Lynn ; OKeeffe, Terence ; Tang, Andy L. ; Wynne, Julie L. ; Rhee, Peter. / 14 French pigtail catheters placed by surgeons to drain blood on trauma patients : Is 14-Fr too small?. In: Journal of Trauma and Acute Care Surgery. 2012 ; Vol. 73, No. 6. pp. 1423-1427.
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abstract = "BACKGROUND: Small 14F pigtail catheters (PCs) have been shown to drain air quite well in patients with traumatic pneumothorax (PTX). But their effectiveness in draining blood in patients with traumatic hemothorax (HTX) or hemopneumothorax (HPTX) is unknown. We hypothesized that 14F PCs can drain blood as well as large-bore 32F to 40F chest tubes. We herein report our early case series experience with PCs in the management of traumatic HTX and HPTX. METHODS: We prospectively collected data on all bedside-inserted PCs in patients with traumatic HTX or HPTX during a 30-month period (July 2009 through December 2011) at our Level I trauma center. We then compared our PC prospective data with our trauma registry-derived retrospective chest tube data (January 2008 through December 2010) at our center. Our primary outcome of interest was the initial drainage output. Our secondary outcomes were tube duration, insertion-related complications, and failure rate. For our statistical analysis, we used the unpaired Student's t-test, χ test, and Wilcoxon rank-sum test; we defined significance by a value of p < 0.05. RESULTS: A total of 36 patients received PCs, and 191 received chest tubes. Our PC group had a higher rate of blunt mechanism injuries than our chest tube group did (83 vs. 62{\%}; p = 0.01). The mean initial output was similar between our PC group (560 ± 81 mL) and our chest tube group (426 ± 37 mL) (p = 0.13). In the PC group, the tube was inserted later (median, Day 1; interquartile range, Days 0-3) than the tube inserted in our chest tube group (median, Day 0; interquartile range, Days 0-0) (p < 0.001). Tube duration, rate of insertion-related complications, and failure rate were all similar. CONCLUSION: In our early experience, 14F PCs seemed to drain blood as well as large-bore chest tubes based on initial drainage output and other outcomes studied. In this early phase, we were being selective in inserting PCs in only stable blunt trauma patients, and PCs were inserted at a later day from the time of the initial evaluation. In the future, we will need a larger sample size and possibly a well-designed prospective study. LEVEL OF EVIDENCE: Therapeutic study, level V.",
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T1 - 14 French pigtail catheters placed by surgeons to drain blood on trauma patients

T2 - Is 14-Fr too small?

AU - Kulvatunyou, Narong

AU - Joseph, Bellal

AU - Friese, Randall S.

AU - Green, Donald

AU - Gries, Lynn

AU - OKeeffe, Terence

AU - Tang, Andy L.

AU - Wynne, Julie L.

AU - Rhee, Peter

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N2 - BACKGROUND: Small 14F pigtail catheters (PCs) have been shown to drain air quite well in patients with traumatic pneumothorax (PTX). But their effectiveness in draining blood in patients with traumatic hemothorax (HTX) or hemopneumothorax (HPTX) is unknown. We hypothesized that 14F PCs can drain blood as well as large-bore 32F to 40F chest tubes. We herein report our early case series experience with PCs in the management of traumatic HTX and HPTX. METHODS: We prospectively collected data on all bedside-inserted PCs in patients with traumatic HTX or HPTX during a 30-month period (July 2009 through December 2011) at our Level I trauma center. We then compared our PC prospective data with our trauma registry-derived retrospective chest tube data (January 2008 through December 2010) at our center. Our primary outcome of interest was the initial drainage output. Our secondary outcomes were tube duration, insertion-related complications, and failure rate. For our statistical analysis, we used the unpaired Student's t-test, χ test, and Wilcoxon rank-sum test; we defined significance by a value of p < 0.05. RESULTS: A total of 36 patients received PCs, and 191 received chest tubes. Our PC group had a higher rate of blunt mechanism injuries than our chest tube group did (83 vs. 62%; p = 0.01). The mean initial output was similar between our PC group (560 ± 81 mL) and our chest tube group (426 ± 37 mL) (p = 0.13). In the PC group, the tube was inserted later (median, Day 1; interquartile range, Days 0-3) than the tube inserted in our chest tube group (median, Day 0; interquartile range, Days 0-0) (p < 0.001). Tube duration, rate of insertion-related complications, and failure rate were all similar. CONCLUSION: In our early experience, 14F PCs seemed to drain blood as well as large-bore chest tubes based on initial drainage output and other outcomes studied. In this early phase, we were being selective in inserting PCs in only stable blunt trauma patients, and PCs were inserted at a later day from the time of the initial evaluation. In the future, we will need a larger sample size and possibly a well-designed prospective study. LEVEL OF EVIDENCE: Therapeutic study, level V.

AB - BACKGROUND: Small 14F pigtail catheters (PCs) have been shown to drain air quite well in patients with traumatic pneumothorax (PTX). But their effectiveness in draining blood in patients with traumatic hemothorax (HTX) or hemopneumothorax (HPTX) is unknown. We hypothesized that 14F PCs can drain blood as well as large-bore 32F to 40F chest tubes. We herein report our early case series experience with PCs in the management of traumatic HTX and HPTX. METHODS: We prospectively collected data on all bedside-inserted PCs in patients with traumatic HTX or HPTX during a 30-month period (July 2009 through December 2011) at our Level I trauma center. We then compared our PC prospective data with our trauma registry-derived retrospective chest tube data (January 2008 through December 2010) at our center. Our primary outcome of interest was the initial drainage output. Our secondary outcomes were tube duration, insertion-related complications, and failure rate. For our statistical analysis, we used the unpaired Student's t-test, χ test, and Wilcoxon rank-sum test; we defined significance by a value of p < 0.05. RESULTS: A total of 36 patients received PCs, and 191 received chest tubes. Our PC group had a higher rate of blunt mechanism injuries than our chest tube group did (83 vs. 62%; p = 0.01). The mean initial output was similar between our PC group (560 ± 81 mL) and our chest tube group (426 ± 37 mL) (p = 0.13). In the PC group, the tube was inserted later (median, Day 1; interquartile range, Days 0-3) than the tube inserted in our chest tube group (median, Day 0; interquartile range, Days 0-0) (p < 0.001). Tube duration, rate of insertion-related complications, and failure rate were all similar. CONCLUSION: In our early experience, 14F PCs seemed to drain blood as well as large-bore chest tubes based on initial drainage output and other outcomes studied. In this early phase, we were being selective in inserting PCs in only stable blunt trauma patients, and PCs were inserted at a later day from the time of the initial evaluation. In the future, we will need a larger sample size and possibly a well-designed prospective study. LEVEL OF EVIDENCE: Therapeutic study, level V.

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KW - Chest wall trauma

KW - hemothorax

KW - pigtail catheter

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