Pigtail Catheter Placement for Pneumothorax

Traditionally, a pneumothorax has been treated with a large bore chest tube connected to suction, with inpatient observation until the chest tube can be pulled.   The patient, if stable, would then be discharged home.  Persistent discomfort, infection, and other complication rates are not insignificant.

More recently, there has been a push to treat stable small pneumothoraces with less invasive methods such as observation or small bore chest tubes. In cases of unstable patients or those with hemopneumothoraces, a large bore chest tube continues to be the most appropriate treatment.

Pigtail Catheter Indications

  • Drainage of air or thin simple fluid
  • Current teaching is for PTX usage only if <40%
  • How to know if fluid is simple? Lateral decub XR to see if fluid layers out onto the side

 

Hunting and Gathering

Find a workstation on wheels (WOW) with a functioning Topaz to obtain informed consent

Supplies

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  • Pigtail Catheter kits are currently not kept in clean utility rooms or in the critical care rooms. You will need to CALL SUPPLY and have them bring you a kit.
  • Extra 1% lidocaine
  • Sterile Gloves
  • Sterile Gown
  • Hat
  • Mask with eye shield
  • Sterile flush or 10cc of sterile saline

Setup

  • Patient Position: supine with arm above head, same as for a thoracostomy tube. Consider soft restraints to help the patient keep the arm in position.
  • Draw up your lidocaine into the provided syringe
  • Place the dilator all the way into the pigtail catheter
  • Prep the guidewire into the red applicator
  • Load the finder needle syringe with 3-4cc of sterile saline. Or take the sterile flush and discard 6-7cc of saline. Connect to the finder needle

The Procedure

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