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Am J Emerg Med

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Am J Emerg Med

血脂异常 达标率

Am J Emerg Med. 2010 Oct;28(8):915-21. Epub 2010 Feb 25.

    Ultrasound-guided pigtail catheters for drainage of various pleural diseases. Liu YH, Lin YC, Liang SJ, Tu CY, Chen CH, Chen HJ, Chen W, Shih CM, Hsu WH.

    SourceDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan.

Abstract

    OBJECTIVE: Little is known about the efficacy and safety of ultrasound-guided pigtail catheters for the management of various pleural diseases in the emergency department, ward, and intensive care unit.

    METHODS: We conducted a retrospective study in a university hospital during a 1-year interval.

    RESULTS: A total of 276 patients (178 men and 98 women) underwent 332 pigtail catheters (the drain size ranged from 10F to 16F) under ultrasound guidance. The mean ? SEM patient age was 59 ? 18 years, and mean duration of drainage was 6.1 ? 2 days. A total of 64 drains (19.2%) were inserted for pneumothoraces; 98 drains (29.5%), for malignant effusions; 119 drains (35.8%), for parapneumonic effusions/empyemas; and 38 drains (11.4%), for massive transudate pleural effusions. The overall success rate was 72.9%. The success rate was highest when the drain was used to treat massive transudate effusions (81.6%) and malignant pleural effusions (75.5%), followed by parapneumonic effusions/empyemas (72.2%), hemothoraces (66.6%), and pneumothoraces (64.0%). Only 10 (3.0%) drains had complications due to the procedure, including infection (n = 4, 1.2%), dislodgment (n = 4, 1.2%), wound bleeding at the pigtail catheter puncture area complicated with hemothoraces (n = 1, 0.3%), and lung puncture (n = 1, 0.3%). There was no significant difference in success rate when different catheter sizes were used to treat pleural diseases.

    CONCLUSIONS: Ultrasound-guided pigtail catheters provide a safe and effective method of draining various pleural diseases. We strongly suggest that ultrasound-guided pigtail catheters be considered as the initial draining method for a variety of pleural diseases.

Am J Emerg Med. 2010 Oct 20. [Epub ahead of print]

    Secondary spontaneous pneumothorax: which associated condition is benefit for pigtail catheter treatment?

    Chen CH, Liao WC, Liu YH, Chen WC, Hsia TC, Hsu WH, Shih CM, Tu CY.

    SourceDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan.

Abstract

    OBJECTIVE: The study aimed to assess the clinical efficacy of pigtail catheter drainage for patients with a first episode of secondary spontaneous pneumothorax (SSP) and different associated

conditions.

    METHODS: We retrospectively reviewed the records of patients with SSP who received pigtail catheter drainage as their initial management between July 2002 and October 2009. A total of 168 patients were included in the analysis; 144 (86%) males and 24 (14%) females with a mean age of 60.3 ? 18.3 years (range, 17-91 years). Data regarding demographic characteristics, pneumothorax size, complications, treatments, length of hospital stay, and associated conditions were analyzed.

    RESULTS: In total, 118 (70%) patients were successfully treated with pigtail catheter drainage, and 50 (30%) patients required further management. Chronic obstructive lung disease was the most common underlying disease (57% of cases). Secondary spontaneous pneumothorax associated with infectious diseases had a higher rate of treatment failure than SSP associated with obstructive lung conditions (19/38 [50%] successful vs 78/104 [75%] successful, P = .004) and malignancy (19/38 [50%] successful vs 13/16 [81%] successful, P = .021). Moreover, patients with SSP associated with infectious diseases had a longer length of hospital stay than those with obstructive lung conditions (23.8 vs 14.5 days, P = .003) and malignancy (23.8 vs 12.1 days, P = .017). No complications were associated with pigtail catheter drainage.

    CONCLUSIONS: A higher rate of treatment failure was noted in SSP patients with infectious diseases; thus, pigtail catheter drainage is appropriate as an initial management for patients with SSPs associated with obstructive lung conditions and malignancy.

Am J Emerg Med. 2010 May;28(4):466-71. Epub 2010 Jan 28.

    Pigtail catheter for the management of pneumothorax in mechanically ventilated patients. Lin YC, Tu CY, Liang SJ, Chen HJ, Chen W, Hsia TC, Shih CM, Hsu WH.

    SourceDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.

Abstract

    PURPOSE: There has been a paucity of data regarding the efficacy and safety of small-bore chest tubes (pigtail catheter) for the management of pneumothorax in mechanically ventilated patients.

    METHODS: We conducted a retrospective review of mechanically ventilated patients who underwent pigtail catheter drainage as their initial therapy for pneumothorax in the emergency department and intensive care unit from January 2004 through January 2007 in a university hospital.

    RESULTS: Among the 62 enrolled patients, there were 41 men (66%) and 21 women (34%), with a mean age of 63.8 +/- 20.3 years. A total of 70 episodes of pneumothoraces occurred in the intensive care unit, and 48 episodes of pneumothoraces (68.6%) were successfully treated with pigtail catheters. The average duration of pigtail drainage was 5.9 days (1-27 days). No major complications occurred through use of this procedure, except for pleural infections (n = 3, 4.2%)

    and clogged tube (n = 1, 1.4%). Comparing the variables between the success and failure of pigtail treatment, the failure group had a significantly higher proportion of Fio(2) >60% requirement (45.5% vs. 14.6%, P = .005) and higher positive end-expiratory pressure levels (8.7 +/- 3.0 vs. 6.2+/- 2.3 mm Hg, P = .001) at the time of pneumothorax onset than the success group. Further comparing the efficacy of pigtail drainage between barotraumas and iatrogenic pneumothorax, pigtail catheters for management of iatrogenic pneumothorax had a significantly higher success rate than barotraumas (87.5% vs. 43.3%, P < .0001).

    CONCLUSION: Pigtail catheter drainage is relatively effective in treating iatrogenic but less promising for barotraumatic pneumothoraces.

(c) 2010 Elsevier Inc. All rights reserved.

PMID:20466227[PubMed - indexed for MEDLINE] MeSH TermsMeSH

    TermsAdolescentAdultAgedAged, 80 and overChest Tubes*/adverse

    effectsDrainage/methodsEmergency Service, HospitalEquipment FailureFemaleHospital MortalityHumansIntensive Care UnitsMaleMiddle

    AgedPneumothorax/mortalityPneumothorax/physiopathologyPneumothorax/therapy*Positive-Pressure RespirationRespiration, Artificial*Retrospective StudiesTreatment OutcomeYoung Adult LinkOut - more resourcesFull Text SourcesElsevier ScienceEBSCOMD ConsultOhioLINK Electronic Journal CenterOvid Technologies, Inc.Swets Information ServicesMedicalPleural Disorders - MedlinePlus Health Information

Adv Neonatal Care. 2009 Feb;9(1):7-16.

    Pigtail catheters used in the treatment of pneumothoraces in the neonate.

    Cates LA.

    SourceAuthor Affiliations: Newborn Service, Texas Children's Hospital, Houston; and School of Nursing, University of Texas Medical Branch, Galveston, USA. locates@utmb.edu

Abstract

    Air leak in the neonatal population can be a deadly situation. Neonates have many risk factors that can contribute to air leak. These include, but are not limited to, respiratory distress syndrome; mechanical ventilation; sepsis; pneumonia; aspiration of meconium, blood, or amniotic fluid; and congenital malformations. In the NICU, the staff must be prepared to diagnose and treat pneumothoraces in a timely manner. Pathophysiology of air leaks in the neonate including the anatomy of the chest and diagnosis, indications, and common methods for the treatment of a pneumothorax in an infant is explained in this article. In addition, the latest form of treatment for neonates, known as the modified pigtail catheter, is described. A comprehensive literature review of the evidence behind the use of the pigtail catheter in neonates will be incorporated. Finally, the step-by-step placement of this catheter using the modified Seldinger technique will be illustrated and described in detail.

Intensive Care Med. 2009 Feb;35(2):350-4. Epub 2008 Oct 11.

    Application of ultrasound-guided pigtail catheter for drainage of pleural effusions in the ICU.

Liang SJ, Tu CY, Chen HJ, Chen CH, Chen W, Shih CM, Hsu WH.

    SourceDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, No.2 Yuh Der Road, Taichung, Taiwan.

Abstract

    BACKGROUND: Little is known about the effectiveness of the pigtail catheter for drainage of pleural effusions in the intensive care unit (ICU).

    METHODS: We conducted a retrospective review of adult patients (>/=18 years) who underwent ultrasound-guided pigtail catheter drainage of pleural effusions in the ICUs from January 2005 to July 2007 in a university hospital.

    RESULTS: Among the 133 enrolled patients, there were 93 (70%) males and 40 (30%) females, with a mean age of 63.7 +/- 15.4 years old. The reasons for pigtail drainage were as follows: thoracic empyema (n = 59, 44%), massive transudative pleural effusions (n = 33, 25%), postoperative pleural effusion (n = 29, 15%), malignant pleural effusion (n = 18, 14%) and traumatic hemothorax (n = 3, 2%). In comparing the total amount of fluids drained, the duration of drainage, success rate and complication rate among these different causes of pleural effusion, pigtail drainage for massive transudative pleural effusion yielded the largest amount of pleural fluids (5,382 +/- 4,844 ml), provided the longest duration of drainage (9 +/- 7 days), and had the highest complication rate (18%). The success rate was highest when used to treat traumatic hemothorax (100%) and postoperative pleural effusions (85%); drains inserted for empyema were more likely to fail (overall success rate, 42%). No significant insertion complications, such as hollow organ perforation, were caused by this procedure.

    CONCLUSION: The ultrasound-guided pigtail catheter inserted by intensivists is a well-tolerated and effective method of draining all kinds of pleural effusions in critically ill patients. We suggest that pigtail catheter drainage be considered as the initial treatment of choice in the ICU.

Am J Emerg Med. 2006 Nov;24(7):795-800.

    Pigtail catheters vs large-bore chest tubes for management of secondary spontaneous pneumothoraces in adults.

    Tsai WK, Chen W, Lee JC, Cheng WE, Chen CH, Hsu WH, Shih CM.

    SourceDepartment of Internal Medicine, Division of Chest Medicine, China Medical University Beigang Hospital, Yulin 651, Taiwan.

Abstract

    It is still uncertain if large-bore chest tubes (20F-28F) is superior to pigtail catheter (10F-14F) in terms of the management of secondary spontaneous pneumothoraces (SSP). This study was designed to compare the efficacy and safety associated with placement of large-bore chest tubes vs pigtail catheters in adults experiencing the first episode of SSP. We conducted a retrospective chart review of 91 patients experiencing the first episode of SSP in a university hospital over a 3.5-year period who received treatment by either a large-bore chest tube or a pigtail catheter.

    Any patient who was younger than 18 years or experiencing mechanical ventilation-related barotraumas or pyopneumothorax was excluded from this study. Various parameters including demographical characteristics, size of pneumothorax, complications, time of pigtail or chest tube extubation, and length of hospital stay were collected and analyzed. Among the enrolled 91 patients, including 76 (83.5%) men with a mean age of 60 +/- 19 years, 69 were initially treated with a pigtail, and 22 patients received conventional chest tubes. Fifty patients (72.5%) undergoing the pigtail drainage and 16 (72.7%) undergoing large-bore chest tube treatment of SSP were successfully treated (P = .88). In addition, there was no significant difference in terms of length of hospital stay, extubation time, recurrence rate, and complication. Pigtail catheters offer a safe and effective alternative for large-bore chest tubes to adult patients experiencing the first episode of SSP, and we strongly suggested that pigtail tube drainage should be considered as the initial treatment of choice.

QJM. 2006 Jul;99(7):489-91. Epub 2006 Jun 29.

    Pigtail catheter drainage for secondary spontaneous pneumothorax.

    Chen CH, Chen W, Hsu WH.

Aust Nurs J. 2005 May;12(10):19-20.

    Pigtail drain tubes: a guide for nurses.

    Hayes D.

    SourceWestern Hospital, Melbourne, Victoria.

J Invasive Cardiol. 2006 Jan;18(1):38.

    Myocardial staining during left ventriculography with a pigtail catheter.

    Martín M, Lozano I, Morís C.

    SourceDepartment of Cardiology, Hospital Central de Asturias, Celestino Villamil S/N, Oviedo, Asturias, 33006, Spain.

Eur J Cardiothorac Surg. 2005 Feb;27(2):344.

    Tension pneumopericardium relieved by pigtail catheter.

    Yadav S, Sadasivan D, Sharma S.

    SourceDepartment of Cardiothoracic Surgery, Fremantle Hospital, Fremantle, WA 6160 Australia. s_yadava@rediffmail.com

PMID:15691694[PubMed - indexed for MEDLINE]

    Pleurodesis with iodized talc for malignant effusions using pigtail catheters RL Thompson, JC Yau, RF Donnelly, DJ Gowan and FR Matzinger

    Abstract

    OBJECTIVE: To assess the efficacy of using an iodized talc slurry as a sclerosing agent instilled into the pleural space via a 12-French pigtail catheter for controlling malignant pleural effusions. DESIGN: A prospective study in which patients were followed until their death. SETTING: A university-affiliated tertiary-care teaching hospital. PATIENTS: Medical oncology patients

    admitted with symptomatic malignant pleural effusions were considered for iodized talc pleurodesis. MAIN OUTCOME MEASURES: The control of pleural effusion. Treatment failure was defined as any reaccumulation of fluid in the pleural space. RESULTS: Fifteen patients were treated for a total of 17 instillations. The median follow-up on all patients until death was 6 months (range 1-20). The most frequent adverse effect in the study group was pleuritic chest pain (60%). The probability of control of effusion, as determined by the method of Kaplan-Meier, was 81% (SEM 9.7%). The cost of preparing 5 g of iodized talc was $4.32 (US). CONCLUSIONS: Iodized talc slurry instilled through a small-bore pigtail catheter is a safe, economical, and effective treatment for malignant pleural effusion.

Gynecol Oncol. 1994 Aug;54(2):215-7.

    Pleural effusions: outpatient management with pigtail catheter chest tubes.

    Van Le L, Parker LA, DeMars LR, MacKoul P, Fowler WC.

    SourceDepartment of Obstetrics and Gynecology, University of North Carolina, Chapel Hill 27599-7570.

Abstract

    Pulmonary effusions associated with ovarian cancer indicate advanced disease. Although many patients tolerate these effusions, some are symptomatic and manifest respiratory distress. Therapeutic sclerosis of the pleural cavity is successful in some patients; however, not all patients are relieved of respiratory symptoms. We present two symptomatic patients in whom sclerosis was unsuccessful or not an option; their respiratory symptoms were relieved with placement of pigtail catheter chest tubes that allowed discharge from the hospital and management at home. Catheters were easy to manage at home and there were no infectious complications.

Clin Radiol. 1995 Jan;50(1):15-9.

    Ultrasound-guided pigtail catheter drainage of malignant pericardial effusions. Hingorani AD, Bloomberg TJ.

    SourceDepartment of Medicine, Royal Surrey County Hospital, Guildford.

Abstract

    Anterior pericardiocentesis was performed under ultrasound guidance using indwelling pigtail catheters in nine patients with malignant pericardial effusions and cardiac tamponade. Symptoms were alleviated in all cases and there were no deaths attributable to the procedure. Catheters remained in place for a median of 24 h (range 8-168 h). Complications were minor: asymptomatic left-sided or bilateral pleural effusions (n = 3), atrial fibrillation (n = 2), transient pericardial pain (n = 1) and erratic drainage (n = 1). Recurrence of the pericardial effusion was limited to a single case and occurred after 5 months of effective palliation. The procedure was successfully repeated with no further recurrence. One patient who went on to surgical fenestration 11 days after pericardiocentesis died 24 h post-operatively. The remaining patients died of the underlying malignant disease without further cardiac complication. Survival following the procedure ranged from 3 to 8 months. Ultrasound-guided pigtail catheter drainage is a minimally invasive, safe and effective method for the palliation of cardiac tamponade in patients with malignant pericardial disease.

Drainage catheters: in vitro comparison of internal retention mechanisms.

    K K Chan, H B D'Agostino, A F Carrillo, R O'Laoide and M Vasconcellos-Vieira + Author Affiliations

    Interventional Radiology Service, Department of Radiology, University of California San Diego Medical Center, San Diego, CA 92103-8756, USA.

    Abstract

    In five drainage catheters, internal retention mechanisms (locking pigtail [14 and 8 F], inflatable balloon [14 F], or wings [14 and 24 F]) were evaluated for resistance to and distortion from dislodgment. Catheters were inserted into simulated tissue, and weight was added until dislodgment occurred. Resistance to dislodgment increased when the mechanisms were locked; the locking pigtail supported the most weight. Distortion caused by dislodgment was minimal.

J Ultrasound Med. 1997 Aug;16(8):565-7.

    Pleurosubcutaneous fistula after percutaneous pigtail catheter insertion.

    Hua CC, Chen CJ.

    SourceDepartment of Internal Medicine, Chang Gung Memorial Hospital, Taiwan, Republic of China.

Nursing. 1992 Jun;22(6):52-3.

    Caring for the patient with a pigtail drainage catheter.

    Burns J.

    PMID:1614654[PubMed - indexed for MEDLINE]

J Endourol. 2000 Nov;14(9):735-7; discussion 737-8.

    Nephrostomy tube after percutaneous nephrolithotomy: large-bore or pigtail catheter? Maheshwari PN, Andankar MG, Bansal M.

    SourceR.G. Stone Urological Research Institute, Mumbai, India. calgrse@bom5.vsnl.net.in

Abstract

    BACKGROUND AND PURPOSE: A nephrostomy tube is an integral part of any percutaneous renal surgery. Commonly, a nephrostomy tube that is 2F to 3F smaller than the percutaneous tract is used after percutaneous nephrolithotomy (PCNL). In our experience, quite a few patients have pain at the nephrostomy tube site, and many patients complain of a prolonged urinary leak after tube removal when a large nephrostomy tube is used. This prospective study was planned to document whether these symptoms could be attributed to the size of the nephrostomy tube and whether a small pigtail catheter could reduce these problems without increasing complications.

    PATIENTS AND METHODS: Forty well-matched patients in whom a one-stage PCNL was done for calculus disease were studied prospectively. Alternate patients had a 28F nephrostomy tube or a 9F pigtail catheter placed at the end of the procedure. Patients were observed for the duration of hematuria, number of analgesic injections needed, and the duration of urinary leak after tube removal.

    RESULTS: The groups were comparable in the amount and duration of hematuria after PCNL. There was a statistically significant difference in the analgesic need and the duration of urinary leak after tube removal, both of which were less in patients having a pigtail catheter.

    CONCLUSIONS: A pigtail catheter nephrostomy tube after PCNL reduces the hospital stay by reducing the duration of the urinary leak. The postoperative course is smooth, as patient has less pain and needs less analgesic support. There is no statistically significant increase in the postoperative bleeding secondary to use of a pigtail catheter. Second-look nephroscopy was easy in the one patient with a pigtail nephrostomy catheter who needed the procedure.

Pediatr Emerg Care. 2002 Aug;18(4):265-7.

    Pigtail catheters versus large-bore chest tubes for pneumothoraces in children treated in the emergency department.

    Dull KE, Fleisher GR.

    SourceDivision of Emergency Medicine, Children's Hospital, Boston, MA, USA.

    Karen.Dull@TCH.Harvard.edu

Abstract

    OBJECTIVE: We sought to compare the efficacy (pneumothorax resolution and hospitalization days), pain (narcotic usage), and safety (need for repositioning or replacement) associated with placement of large-bore chest tubes versus pigtail catheters in children with pneumothoraces.

    METHODS: We conducted a retrospective chart review of all patients with pneumothoraces seen in the emergency department (ED) over a 6.5-year period who received treatment by a pediatric emergency physician with either a large-bore chest tube or a pigtail catheter. We excluded patients who had catheters placed by other specialists and patients who were endotracheally intubated. We collected the following data: complications, hospital days to discharge, and narcotic pain medications taken.

    RESULTS: Eleven pigtail catheters and 16 large-bore chest tubes were placed. All pneumothoraces were effectively evacuated. Three of the 11 pigtail catheters required repositioning, and one was replaced. Two of the 16 large-bore chest tubes were repositioned, and one was replaced; additionally, a pigtail catheter was added to one patient with a large-bore chest tube to facilitate evacuation of the air. Average hospital stay was similar between groups (6.2 d for pigtail catheters vs 6.8 d for large-bore chest tubes, = 0.74). Children with pigtail catheters required less narcotic pain medications than those who had large-bore chest tubes, but the differences were not significant.

    CONCLUSION: Pigtail catheters offer a safe and effective alternative to large-bore chest tubes for patients receiving treatment for pneumothoraces in the ED.

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