Pleural drainage using central venous catheters

Singh Kulgit, Loo Shi, Bellomo, Bellomo Rinaldo

Description

The objective of the present study was to evaluate the use of a single lumen 16 G central venous catheter for the drainage of uncomplicated pleural effusions in intensive care unit patients. Methods A prospective observational study was performed in two intensive care units of university-affiliated hospitals. The study involved 10 intensive care unit patients with non-loculated large effusions. A 16 G central venous catheter was inserted at the bedside without ultrasound guidance using the Seldinger technique. The catheter was left in situ until radiological resolution of the effusion. Results Fifteen sets of data were obtained. The mean and standard deviation of the volumes drained at 1, 6 and 24 hours post catheter insertion were 454 ± 241 ml, 756 ± 403 ml and 1010 ± 469 ml, respectively. The largest volume drained in a single patient was 6030 ml over 11 days. The longest period for which the catheter remained in situ without evidence of infection was 14 days. There were no instances of pneumothorax, hemothorax, re-expansion pulmonary edema and catheter blockage/ disconnections. Conclusions The use of an indwelling 16 G central venous catheter is efficacious in draining uncomplicated large pleural effusions. It is well tolerated by patients and is associated with minimal complications. It has the potential to avoid repeated thoracentesis or the use of large-bore chest tubes.

Sujets

• Central venous catheter
• Drainage
• Pleural effusion

Informations

• Publié par: biomed
• Publié le: 01 janvier 2003
• Nombre de lectures: 9
• Langue: English

Extrait

Available onlinehttp://ccforum.com/content/7/6/R191

Research Pleural drainage using central venous catheters 1 23 Kulgit Singh, Shi Looand Rinaldo Bellomo

Open Access

1 Consultant, Department of Anaesthesiology, Tan Tock Seng Hospital, Singapore 2 Senior Consultant, Department of Anaesthesiology, Tan Tock Seng Hospital, Singapore 3 Professor of Medicine, University of Melbourne, and Director of Intensive Care Research, Department of Intensive Care, Austin & Repatriation Medical Centre, Heidelberg, Melbourne, Victoria, Australia

Correspondence: Kulgit Singh, [e-mail]

Received: 15 September 2003

Revisions requested: 17 September 2003

Revisions received: 24 September 2003

Accepted: 25 September 2003

Published: 15 October 2003

Critical Care2003,7:R191R194 (DOI 10.1186/cc2393) This article is online at http://ccforum.com/content/7/6/R191 © 2003 Singhet al., licensee BioMed Central Ltd (Print ISSN 13648535; Online ISSN 1466609X). This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

Abstract IntroductionThe objective of the present study was to evaluate the use of a single lumen 16G central venous catheter for the drainage of uncomplicated pleural effusions in intensive care unit patients. MethodsA prospective observational study was performed in two intensive care units of university affiliated hospitals. The study involved 10intensive care unit patients with nonloculated large effusions. A 16G central venous catheter was inserted at the bedside without ultrasound guidance using the Seldinger technique. The catheter was leftin situuntil radiological resolution of the effusion. ResultsFifteen sets of data were obtained. The mean and standard deviation of the volumes drained at 1, 6 and 24hours post catheter insertion were 454± 241 ml,756 ± 403 mland 1010± 469 ml, respectively. The largest volume drained in a single patient was 6030ml over 11days. The longest period for which the catheter remainedin situwithout evidence of infection was 14 days. There were no instances of pneumothorax, hemothorax, reexpansion pulmonary edema and catheter blockage/ disconnections. ConclusionsG central venous catheter is efficacious in drainingThe use of an indwelling 16 uncomplicated large pleural effusions. It is well tolerated by patients and is associated with minimal complications. It has the potential to avoid repeated thoracentesis or the use of largebore chest tubes.

Keywordscentral venous catheters, drainage, pleural effusion

Introduction

A recent study confirmed the high incidence of pleural effu sions in patients in the intensive care unit (ICU). Using criteria based on the physical examination and evaluation of chest radiographs, an annual incidence of 8.4% was recorded [1]. This incidence would probably be higher if diagnostic modali ties such as ultrasound were employed [2]. The presence of a pleural effusion has diagnostic and therapeutic implications [3]. Large effusions can compress the underlying lung, result ing in atelectasis and impaired gas exchange. This may pre cipitate the need for invasive mechanical ventilation or may delay endotracheal decannulation.

ICU = intensive care unit.

Current common practices to drain uncomplicated pleural effusions include thoracentesis via small gauge needles or trocar/venulae systems, or the use of largebore chest tubes placed at the bedside or of smallbore pigtail catheters placed under radiographic guidance [4,5]. Loculated effu sions and empyemas may require surgical drainage. Each technique has its advantages and limitations. We hypothe sised that by using an indwelling 16G single lumen central venous catheter in uncomplicated large effusions, we would be able to avoid repeated thoracentesis procedures and to successfully drain large effusions with minimal complications. To test the efficacy of this approach we conducted a prospective observational study.

R191