Chest
Volume 94, Issue 1, July 1988, Pages 55-57
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Clinical Investigations
Treatment of Pneumothoraces Utilizing Small Caliber Chest Tubes

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Pneumothorax is a common problem in both hospitalized and emergency room patients. Eight-four pneumothoraces in 79 patients were treated using a No. 9 French catheter. In 76 cases, the catheter was attached to a flutter valve, and in eight cases, suction was applied. The No. 9 French catheter provided definitive treatment in 73 (87 percent) of the pneumothoraces. Causes of catheter failure included kinking, malposition, inadvertent removal by patient, occlusion of the tube or valve by pleural fluid, and large air leak. No complication attributable to tube placement occurred. When the flutter valve was employed, the patient was able to ambulate allowing for potential outpatient therapy The tube was found to be easy to use, safe, and efficacious in the treatment of pneumothoraces.

Section snippets

Materials and Methods

From April 1981 to September 1987, a total of 84 pneumothoraces in 79 patients were treated with small caliber chest tubes. Of this group, 56 were men and 28 were women. Their ages ranged from 21 to 85 years, with an average age of 57.2 years. The causes of the pneumothoraces were as follow: percutaneous needle biopsy (54), spontaneous (14), central line placement (eight), barotrauma (three), postthoracotomy (two), bronchoscopic biopsy (one), mediastinoscopy (one), and intercostal nerve block

Results

Of the 84 small chest tubes inserted, 73 (87 percent) provided definitive treatment of the pneumothorax. Eleven small chest tubes were placed which required some form of additional intervention to treat the pneumothorax. Four of the tubes failed to evacuate any of the pneumothorax. Two of these folded back on themselves in the pleural space which kinked and occluded the tube. Another tube was placed in the major fissure, and subsequently, would not evacuate air. The fourth tube in this group

Discussion

The use of small caliber chest tubes in the treatment of pneumothoraces was initially described by Sargent and Turner.6 They employed a No. 9 French catheter in combination with a flutter valve developed by Heimlich.7 This sytem was easy to insert and required minimal nursing care after placement.

Since then, several series have been reported employing chest tubes (No. 12 to 20 French) and a Heimlich valve in the treatment of spontaneous pneumothoraces.1, 2, 8 These found that the Heimlich valve

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Manuscript received November 5; revision accepted January 20.

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