Elsevier

The Annals of Thoracic Surgery

Volume 64, Issue 5, November 1997, Pages 1437-1440
The Annals of Thoracic Surgery

Outpatient Chest Tube Management

https://doi.org/10.1016/S0003-4975(97)00853-9Get rights and content

Background

Patients with indwelling chest tubes inserted for the purpose of evacuating pleural air traditionally are treated in the hospital. The current emphasis on cost-effective medical care and a recent report describing the early discharge of patients who had undergone lung volume reduction operations and had a persistent air leak prompted us to review our overall experience with outpatient tubes in a general thoracic surgical practice.

Methods

We reviewed the records of patients who had been discharged from the hospital with chest tubes and Heimlich valves in place for venting pleural air over the past 7 years. Ambulatory tube management was used on a total of 240 occasions in three diagnostic groups: pneumothorax (176 cases), prolonged postresection air leak (45 cases), and outpatient thoracoscopic pulmonary wedge excision (19 cases). Failure was defined as hospital admission for complications of tube insertion or function.

Results

There were 10 failures in the entire group (4.2%), 4.5% for pneumothorax, 2% for postresection air leak, and 5.3% for outpatient thoracoscopy. There were no deaths or instances of life-threatening problems. The cost of at least 1,263 inpatient hospital days was saved.

Conclusions

The presence of a chest tube, with or without an air leak, does not always require hospitalization. Admission can be avoided in most patients with primary spontaneous pneumothorax and in selected patients with pneumothorax of other causes. The postoperative hospital stay can be shortened for many patients who have a prolonged air leak after pulmonary resection. Ambulatory tube management also makes feasible outpatient thoracoscopy for noneffusive processes.

Section snippets

Material and Methods

We reviewed the records of our patients during the past 7 years who were followed up on an ambulatory basis with chest tubes in place for the evacuation of pleural air. Patients with open drains for empyema or with space problems and catheters for pleural effusion were not included. Recorded data included age, sex, procedure, presence or absence of an air leak, duration of outpatient use, complications, and hospital admissions. Failure was defined as hospital admission because of problems with

Results

Outpatient chest tube management was used on 240 occasions in 214 patients. The numbers of episodes and patients are discordant because of instances of recurrent ipsilateral or metachronous contralateral pneumothorax. Table 1 summarizes some of the data. Hospital admission for problems of tube placement or function was required in only 10 cases (4.2%). There were no deaths and no instances of serious infection or acute life-threatening pulmonary complications.

The pneumothorax group included 176

Comment

The use of the Heimlich valve for the outpatient treatment of pneumothorax has been reported in the surgical literature. Mercier and associates [1] noted only one tube complication in 169 cases. In a series of 41 cases, Cannon and associates [2] successfully managed 88% of those that required thoracostomy without hospital admission. Nonetheless, hospital admission, large-bore tubes, and suction remain the standard approach in many institutions [4,5]. Even those who favor small-bore catheters

References (12)

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