Specific Drainage Techniques

Chest

• Pleural drainage catheters are smaller than surgical drains (up to 16Fr) – haemothorax is better treated with surgical drains (36–38Fr)

• USS is adequate for uncomplicated collections, but CT is usually needed for drainage of multiloculated pleural collections

• It is recommended that the dependent portion of the collection is accessed just above the adjacent rib (away from the neurovascular bundle) and avoiding insertion close to the scapula

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    ‘Vacuthorax’ phenomenon: a pneumothorax following pleural drainage (due to inadequate surfactant or the presence of restrictive pleural disease precipitating an asymptomatic hydropneumothorax)

• A chest drain placed for a pneumothorax can be removed 24 hours after the pneumothorax has resolved

• Options for a partially treated pleural collection: catheter repositioning / exchange for a larger catheter / instillation of a fibrinolytic agent for an inadequately draining complex collection

• Pleurodesis: this is used to prevent recurrence of effusion or pneumothorax by generating pleural inflammation and fibrosis causing obliteration of the plural space (e.g. with the installation of a chemical agent such as Bleomycin)