Home | About us | Editorial Board | Search | Ahead of print | Current Issue | Archives | Instructions | Online submissionContact Us   |  Subscribe   |  Advertise   |  Login  Page layout
Wide layoutNarrow layoutFull screen layout
Lung India Official publication of Indian Chest Society  
  Users Online: 1815   Home Print this page  Email this page Small font size Default font size Increase font size

  Table of Contents    
Year : 2020  |  Volume : 37  |  Issue : 3  |  Page : 198-203  

The effectiveness of small-bore intercostal catheters versus large-bore chest tubes in the management of pleural disease with the systematic review of literature

1 Flinders Medical Centre, Adelaide, SA, Australia
2 Department of Respiratory Medicine, Royal Darwin Hospital, Darwin, NT, Australia

Date of Submission19-May-2019
Date of Decision12-Oct-2019
Date of Acceptance20-Jan-2020
Date of Web Publication04-May-2020

Correspondence Address:
Dr. Sumit Mehra
Flinders Medical Centre, Bedford Park, Adelaide, SA-5042
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/lungindia.lungindia_229_19

Rights and Permissions

Objective: The purpose of this study was to compare the effectiveness of small-bore intercostal catheters (SB ICCs; 10–14 Fr) to large-bore intercostal tubes (LB ICTs; >20 Fr) in the management of pleural diseases. Methods: A total of 52 patients (42 males) with a mean age of 55 ± 23 years undergoing pleural intervention were included in the analysis. Twenty-five patients (48.1%) had pneumothorax and rest (51.9%) had pleural effusion. Half of the patients underwent SB ICC (mean age: 63 ± 20 years) and the remaining 26 underwent LB ICT (mean age: 47 ± 25 years). Results: SB ICCs were predominantly used in patients with primary pleural effusion and LB ICTs in patients presenting with pneumothorax. Failures were in <20% of SB ICC patients (mainly from loculation) and in <30% with LB ICT patients (from persistent airleak) – difference that was not statistically significant. In both groups, no deaths or major complications directly related to the procedure were observed. However, the proportion that needed surgery was significantly different in two cohorts (18.5% OF SB ICC and 42.3% of LB ICT cohorts). The ICC dwell time was less in SB ICC (5 ± 4 days), compared to LB ICT (8 ± 6 days). SB ICCs were associated with less pain and seem to be tolerated better by the patients. Conclusions: In well-supervised tertiary hospital setting, SB ICCs are as effective as LB ICTs with better patient tolerance, reduced dwell time, and reduced likelihood for surgical intervention.

Keywords: Empyema, intercostal drains, pleural disease, pneumothorax, thoracic surgery

How to cite this article:
Mehra S, Heraganahally S, Sajkov D, Morton S, Bowden J. The effectiveness of small-bore intercostal catheters versus large-bore chest tubes in the management of pleural disease with the systematic review of literature. Lung India 2020;37:198-203

How to cite this URL:
Mehra S, Heraganahally S, Sajkov D, Morton S, Bowden J. The effectiveness of small-bore intercostal catheters versus large-bore chest tubes in the management of pleural disease with the systematic review of literature. Lung India [serial online] 2020 [cited 2021 Jan 19];37:198-203. Available from: https://www.lungindia.com/text.asp?2020/37/3/198/283737

   Introduction Top

Pleural diseases are common clinical problems encountered worldwide. Operative tube thoracostomy with large-bore intercostal tubes (LB ICT; >20 Fr) has conventionally been the standard of care for several decades. More recently, small-bore intercostal catheters (SB ICC; ≤14 Fr) have become an alternative to LB ICTs. SB ICCs have been found to be equally effective though less painful and better tolerated by the patients. Guidewire-guided placement (Seldinger technique)[1] and ultrasound allows for more accurate positioning reducing human error. However, LB ICTs are still used and remain the method of choice in many hospitals.

Smaller tubes are thought to be less effective because of slower drainage rates and are prone to blockage. Park et al.[2] in an ex-vivo experiment found that there was no significant difference in drainage time of bodily fluids of differing viscosity with tubes above 8Fr. In another experiment comparing in-vitro and in-vivo drainage through 19 Fr and 28 Fr tubes found similar rates in vivo.[3] The other argument is the cost-effectiveness associated with LB ICTs.

Most studies promoting SB ICCs have been single tube observational studies. Some of the comparative studies, such as Vedam and Barnes,[4] reported a higher prevalence of combined complications and recurrences with the use of the SB-ICCs (42%) than with the LB-ICTs (16%). In TIME 1 study, the largest prospective randomized trial which compared 12 Fr SB ICC with 24 Fr LB ICTs in malignant pleural effusion, showed larger tubes were more effective for pleurodesis, were associated with fewer complications during insertion, and a lower proportion of falling out questioning previous assumptions.[5]

Aims and objective

Current data remain inconclusive and therefore, choice of the tube size remains controversial.[6] With this background, the aim of this study is to evaluate the effectiveness of SB ICCs versus LB ICTs in the management of pleural diseases in our center. We also tried to briefly review the existing literature on topic.

   Methods Top

This observational study was conducted at a tertiary care university hospital. Fifty-two patients (42 males) with a mean age of 55 ± 23 years who were undergoing pleural intervention were included in the study. The demographic characteristics, diagnosis, indication, intervention, complications, and outcome of the intervention were analyzed. Patients requiring drainage were subjected either to SB ICCs or LB ICTs at the discretion of treating respiratory physicians. All procedures were performed in accordance with stringent hospital procedure protocols and by the experienced respiratory physician or by the supervised trainee. Ultrasound guidance was used when necessary. Patients requiring diagnostic pleural tap and therapeutic pleural drainage were not included in the study.

Initial treatment success was defined as complete resolution of effusion or pneumothorax without ICT/ICC kinking, obstruction, displacement, or needing second intervention such as placement of a second ICT/ICC or surgery.

Twenty-six patients underwent SB ICC (mean age: 63 ± 20 years) and 26 underwent LB ICT (mean age: 47 ± 25 years). The demographic data are detailed in [Table 1].
Table 1: Patients demographics and indication for small-bore intercostal catheter and large-bore intercostal tube

Click here to view


The operative tube thoracostomy method was followed for LB ICT,[7] while the modified Seldinger technique[1] was used for SB ICC. Cook catheter set was the most commonly used for SB ICC.

Statistical analysis

The STATA statistical software (STATA v15.0, Stata Statistical Software: Release 14. College Station, Texas, USA) was used for the analysis. The two-sample t-test with equal variances was used for age comparisons, while the Pearson Chi-square test was used for others with proportions such as sex, procedural indication, intervention outcome, need for second intervention, need for surgery, and complication rates. The two-sample Wilcoxon rank-sum (Mann–Whitney) test was used to assess differences in dwell time and hospital stay.

   Results and Outcome Top

The most commonly used catheters were 14 Fr and 20 Fr in the SB and LB patient groups, respectively. There was a significant trend toward the insertion of SB ICC in patients presenting with malignant pleural effusion, parapneumonic effusion and in pleural effusions in general while LB ICT was favored in patients presenting with spontaneous pneumothorax and hemothorax [Table 1]. There were two deaths in both groups, but they were palliative end-stage cancer patients. In both groups, no deaths or major complications directly related to the procedure were observed. The total complication rate was significantly higher in the large-bore group (26.9% vs. 23.1% respectively, P = 0.032). Position error was the main complication seen in the LB group, while dislodgment was the main complication in the case of small-bore tubes [Table 2].
Table 2: Outcome data for the small-bore intercostal catheter and large-bore intercostal tube cohorts

Click here to view

Almost all patients with LB ICTs complained of pain and need for analgesia, including the use of opiates, which was much higher in this group. The mean duration of analgesia administered in the SB ICC (2 days) was much less than in the LB ICT group (8 days). SB ICCs seem also to be better tolerated by the patients with only 40% needing analgesia.

The success of both SB ICCs and LB ICTs was comparable with failure rates of 19.2% and 26.9%, respectively [Table 2]. Drain failure was predominantly related to loculated effusion in the SB ICC while persistent air-leak was the main reason for failure in large tube group and these occurred with <20% of patients.

About a third of SB ICC patients and half of LB ICT group needed a second procedure, and rate of surgical intervention was significantly higher in the large-bore tube patients (42.3%) than in those who initially received small-bore tubes (18.5%). The ICC dwell time was noted to be shorter in SB ICC.

   Discussion Top

The study shows a trend toward inserting SB ICCs in patients with primary pleural effusion and LB ICT drains in pneumothorax. The most common indication for SB ICC was malignant pleural effusion. All patients with parapneumonic effusion predominantly received SB ICC. There was only one case of hemothorax which received LB ICC.

In the current study, the success rate with SB ICCs was 74.9%. Other previous published studies have reported variable success rates from 72.9% to 93.7% [Table 3].
Table 3: Comparison with other published studies

Click here to view

The pleural procedure success rates are dependent on the indication and ancillary procedures performed. In our study, loculated effusion was a cause of failure in keeping with a study by Bediwyand Amer.[8] However, in a study by Mehta et al.,[9] SB ICC was effective in 94.7%, though 61% of the cohort had loculated effusion. Similar results were noted by Jain et al.[10] This appears presumably related to the routine use of intrapleural fibrinolytic therapy (IPFTs) following the MIST-2 trial,[11] but was not a routine practice to install IPFT agents at our center, during this study period. Most patients with loculated empyema are referred for video-assisted thoracoscopic surgery, although recently, we have increased the use of IPFTs with high success rates.

In our study, we did not find a significant difference in success rates between SB ICCs and LB ICTs (74.9% vs. 72%). Similar results have been noted in other studies in terms of efficacy such as Vedam and Barnes,[4] Lin et al.,[12] and Krishnakumar et al.[13] while higher success rates were also noted with SB ICC among patients with spontaneous pneumothorax in Iepsen and Ringbæk study.[14] Dislodgment as a cause of failure was more common in our study in LB ICT group in comparison to previous studies where it was common in SB ICC group. This was probably related to a higher incidence of inter-hospital transfer in the group. Since the outcome of this study, we have introduced protocols for medical professionals caring for such patients, with noticeable reduction in tube dislodgment rates at our center.

We observed increased need for second intervention and a higher rate of surgical intervention in the LB ICC group (36% vs. 18.5%). Rates of surgical intervention were much higher in our study and may be related to strong cardiothoracic presence in our center or the underlying primary pathology. However, other studies such as Mehta et al.,[9] also suggest LB ICT group had higher surgical intervention rates (14.3% vs. 5.3%).

In this study, SB ICC dwell time was noted to be shorter. The overall hospital stay was prolonged in the SB ICC group though not statistically significant. However, this appears rather due to underlying medical condition rather than pleural procedure related. Hussein et al.[15] and Benton and Benfield[16] suggest a trend toward a longer period of drainage with the LB ICT, while the studies by Iepsen and Ringbæk,[14] Krishnakumar et al.[13] suggest that SB ICC was significantly associated with shorter dwell time. In most studies the median SB ICC dwell time varied between 3 and 7.5 days.[8],[10],[12],[13],[14],[15],[16],[17],[18],[19],[20] In Iepsen and Ringbæk study,[14] shorter duration of hospitalization was also noted in SB ICC group.

In our study cohort, in both groups, no deaths or major complications directly related to the procedure were observed. The findings were similar to that observed in studies by Lin et al.[12] It is not uncommon that pleural procedures can be associated with serious life-threatening complications, especially if performed by less experienced personals.[21] In a UK study, a total of 17 fatalities were reported from 2003 to 2008, secondary to pleural procedure.[22]

Vedam and Barnes[4] noted higher complication and recurrence rates with SB ICC. However, most other studies indicate much higher complication rates with LB ICTs such as Benton and Benfield study (32% vs. 24%), Iepsen and Ringbæk study (27.4% vs. 9.5%; P = 0.026) and Krishnakumar et al. (43.9% vs. 21.66%, P = 0.001).[13],[14],[16] In Benton and Benfield study,[16] a much higher infection rate was noted with large-bore drains (12% skin and 16% pleural infections vs. none in the small-bore group). Similarly, high rates of infection were seen in another study (27.4% vs. 9.5%, P = 0.026).[14]

In terms of complications, as per BTS guidelines, the incidence of injury with large-bore versus small-bore drains was 1.4% versus 0.2%, the incidence of malposition was 6.5% versus 0.6% while the incidence of empyema was 1.4% versus 0.2%. However, the incidence of drain blockage was 5.2% with large tubes versus 8.1% with small drains.[7] The lower major complication in our study is presumably related to procedures being performed by experienced physicians and trainees.

In our study, 40% of SB ICCs needed analgesia for median of 2 days. In comparison, all patients with LB ICTs needed analgesia for a median of 8 days. This has been confirmed in other studies such as Sabry et al.,[18] Lin et al.,[12] Jain et al.,[10] Cafarotti et al.,[23] and Horsley et al.[24] It appears logical as a 32 Fr chest tube which has an outer diameter of 10.7 mm will impinge neurovascular bundle causing pain in contrast to SB ICC (≤14 Fr) with diameter ≤4.7 mm.

Considering the increased patient tolerance of SB ICCs, it is becoming a method of choice for long term management of malignant pleural effusion. Studies by Lambert and Gurgacz (ASERNIP-S),[25] Fysh et al.,[26] Saffran et al.[27] and Musani et al.[28] indicate small-bore catheters provide an efficacious yet cost-effective, minimally invasive outpatient approach compared to other strategies. A review of tunneled pleural catheters in adults with malignant pleural effusions found 19 studies with a total of 1370 patients which showed improved outcome and without any major complications.[29] In the study by Putnam et al.,[30] the median hospitalization time was 1 day for Pleurex patients.

The BTS guidelines recommend that an SB ICC are adequate for most cases of complicated parapneumonic effusion, though there is no consensus on the optimal size.[31] Rahman et al.[32] reviewed 405 patients who participated in the Multi-center Intrapleural Streptokinase Trial[33] and reported that there was no significant difference in the frequency of death or need for thoracic surgery in patients receiving chest tube of varying sizes (<10 Fr, 21/58 (36%); size 10–14 Fr, 75/208 (36%); size 15–20 Fr, 28/70 (40%); size >20 Fr, 30/69 (44%); (P = 0.27).

In traumatic pneumothorax, if it is non-occult, chest tube is needed while in occult pneumothorax, drain is needed only if they are on mechanical ventilation. In all such situations, small-bore drains are recommended initially.[34]

There are certain situations where large-bore tubes are warranted.

Lin et al.[35] did a retrospective review of mechanically ventilated patients who underwent pigtail catheter drainage as their initial therapy for pneumothorax. They found pigtail catheter drainage as relatively effective in treating iatrogenic pneumothorax (due to thoracentesis, the insertion of an indwelling line) with success rate of 87.5% but less promising for barotraumatic pneumothoraces with success in only 43.3% cases.

LB ICTs are recommended for haemothorax. The reason for the recommendation is the blood may contain clots and the volume may be too large. However, there is some data available suggesting smaller drains appear to be as effective.[36],[37] Massive hemorrhage (>1500 mL) or continued drainage of more than 250 mL/h for 4 h though will necessitate the need for surgical intervention.

Our study had some limitations. It was an observational study conducted in a tertiary care referral center with differences in local practice limiting the generalizability of the conclusion. The study was not randomized and the decision to insert SB ICC or LB ICT was solely based on treating clinician's discretion. It may have led to selection bias. Interpretation of the findings may also be affected by variations in the diagnosis between the SB and LB groups. We did not use Intrapleural fibrinolytic therapy, which may have affected the success rates and introduced bias. Further, even though, the standard of care given to the patients in LB ICT and SB ICC was similar in both groups, blinding was not possible considering the nature of the study. The authors acknowledge that this is a very small sample size of patients to advocate firm opinion or conclusion; however, it adds to the limited pool of knowledge in the literature. A large randomized controlled trial with patient stratification based on indication and with a standardized pre- and post-drain care protocol is warranted to help reduce these confounding factors.

   Conclusion and Areas of Further Research Top

In our study, SB ICCs and LB ICTs were similarly effective with success rates of 74.1% and 72%, respectively. SB ICCs were better tolerated with respect to pain and mobility postprocedure. Higher rate of surgical intervention, need for second intervention and longer ICC dwell times were noted in LB ICT group.

With the availability of pleurex catheter, SB ICCs are becoming method of choice in the management of malignant pleural effusion. Intrapleural fibrinolytic therapy has increased the success rate of SB ICC in complicated para-pneumonic effusion. Therefore, small-bore catheter should be considered primary choice in malignant pleural effusion, pneumothorax (except in mechanically ventilated patients), as the parapneumonic effusion/empyema and when pleurodesis is intended. The success of the SB indwelling tunneled catheters suggests that the SB ICC does not commonly become obstructed with fibrin. Imaging guidance must be advocated irrespective of the drain size used. Patients on mechanical ventilation with barotrauma-induced pneumothoraxes are best managed with large-bore chest tubes. The role of small-bore drains in traumatic hemothorax and major thoracic surgery has not been tested and are best managed presently with large-bore catheters.


We would like to acknowledge Dr. Asanga Abheyaratne FRACP. MStat. Renal Physician, The Royal Darwin Hospital, Darwin for help toward statistics.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Seldinger SI. Catheter replacement of the needle in percutaneous arteriography; A new technique. Acta radiol 1953;39:368-76.  Back to cited text no. 1
Park JK, Kraus FC, Haaga JR. Fluid flow during percutaneous drainage procedures: An in vitro study of the effects of fluid viscosity, catheter size, and adjunctive urokinase. AJR Am J Roentgenol 1993;160:165-9.  Back to cited text no. 2
Niinami H, Tabata M, Takeuchi Y, Umezu M. Experimental assessment of the drainage capacity of small silastic chest drains. Asian Cardiovasc Thorac Ann 2006;14:223-6.  Back to cited text no. 3
Vedam H, Barnes DJ. Comparison of large- and small-bore intercostal catheters in the management of spontaneous pneumothorax. Intern Med J 2003;33:495-9.  Back to cited text no. 4
Rahman NM, Pepperell J, Rehal S, Saba T, Tang A, Ali N, et al. Effect of Opioids vs NSAIDs and larger vs smaller chest tube size on pain control and pleurodesis efficacy among patients with malignant pleural effusion: The TIME1 randomized clinical trial. JAMA 2015;314:2641-53.  Back to cited text no. 5
McCracken DJ, Psallidas I, Rehman NM. Chest drain size: Does it matter? Eur J Pulmonol 2018; 20(1-6).  Back to cited text no. 6
Havelock T, Teoh R, Laws D. BTS guidelines for pleural procedures-Pleural Aspiration, chest drain insertion and thoracic ultrasound. Thorax 2010 ;65:i61-i76.  Back to cited text no. 7
Bediwy AS, Amer HG. Pigtail catheter use for draining pleural effusions of various etiologies. ISRN Pulmonol. 2012:143295.  Back to cited text no. 8
Mehta AA, Gupta AS, Mohamed AK. The pigtail catheter for pleural drainage: A less invasive alternative to tube thoracostomy. J Curr Surg 2017;6:52-6.  Back to cited text no. 9
Jain S, Deoskar RB, Barthwal MS, Rajan KE. Study of pigtail catheters for tube thoracostomy. Med J Armed Forces India 2006;62:40-1.  Back to cited text no. 10
Rahman NM, Maskel NA, Davies CW, West A, Teoh R, Arnold A, et al. Primary result of the 2nd Multi-centre Intrapleural Sepsis (MIST2) trial; Randomised trial of intrapleural tPA and DNAse in pleural infection. Thorax 2009;64 Suppl 4:A1.  Back to cited text no. 11
Lin CH, Lin WC, Chang JS. Comparison of pigtail catheter with chest tube for drainage of parapneumonic effusion in children. Pediatr Neonatol 2011;52:337-41.  Back to cited text no. 12
Krishnakumar EV, Anas M, Rennis DK, Thomas VD, Vinod B, et al. Efficacy of drainage of pleural effusion using small bore pleural catheter and conventional thoracostomy using large bore chest tube: A comparative study. Int J Res Med Sci 2015;3:3177-81.  Back to cited text no. 13
Iepsen UW, Ringbæk T. Small-bore chest tubes seem to perform better than larger tubes in treatment of spontaneous pneumothorax. Dan Med J 2013;60:A4644.  Back to cited text no. 14
Hussein RM, Elshahat HM, Ahmed Zidan Abozeid Hashem AS. Study of pigtail catheter and chest tube in management of secondary spontaneous pneumothorax. Egypt J Chest Dis Tuberc 2017;66:107-11.  Back to cited text no. 15
Benton IJ, Benfield GF. Comparison of a large and small-calibre tube drain for managing spontaneous pneumothoraces. Respir Med 2009;103:1436-40.  Back to cited text no. 16
Liu CM, Hang LW, Chen WK, Hsia TC, Hsu WH. Pigtail tube drainage in the treatment of spontaneous pneumothorax. Am J Emerg Med 2003;21:241-4.  Back to cited text no. 17
Sabry M, Emad A, Hamad AM. Small bore catheter versus wide bore chest tube in management of malignant pleural effusions. J Egypt Soc Cardio-Thoracic Surg 2012;20:197-201.  Back to cited text no. 18
Liu YH, Lin YC, Liang SJ, Tu CY, Chen CH, Chen HJ, et al. Ultrasound-guided pigtail catheters for drainage of various pleural diseases. Am J Emerg Med 2010;28:915-21.  Back to cited text no. 19
Gammie JS, Banks MC, Fuhrman CR, Pham SM, Griffith BP, Keenan RJ, et al. The pigtail catheter for pleural drainage: A less invasive alternative to tube thoracostomy. JSLS 1999;3:57-61.  Back to cited text no. 20
Davies HE, Merchant S, McGown A. A study of the complications of small bore 'seldinger' intercostal chest drains. Respirology 2008;13:603-7.  Back to cited text no. 21
Harris A, O'Driscoll BR, Turkington PM. Survey of major complications of intercostal chest drain insertion in the UK. Postgrad Med J 2010;86:68-72.  Back to cited text no. 22
Cafarotti S, Dall'Armi V, Cusumano G, Margaritora S, Meacci E, Lococo F, et al. Small-bore wire-guided chest drains: Safety, tolerability, and effectiveness in pneumothorax, malignant effusions, and pleural empyema. J Thorac Cardiovasc Surg 2011;141:683-7.  Back to cited text no. 23
Horsley A, Jones L, White J, Henry M. Efficacy and complications of small-bore, wire-guided chest drains. Chest 2006;130:1857-63.  Back to cited text no. 24
Gilbert CR, Lee HJ, Sklaski JH, Maldonado F, Bessich J, Choi PJ, et al. The Use of Indwelling Tunneled Pleural Catheters for Recurrent Pleural Effusions in Patients With Hematologic Malignancies: A Multicenter Study. Chest 2015;148:752-8.  Back to cited text no. 25
Fysh ETH, Waterer GW, Kendall PA, Bremner PR, Dina S, Geelhoed E, et al. Indwelling pleural catheters reduce inpatient days over pleurodesis for malignant pleural effusion. Chest 2012;142:394-400.  Back to cited text no. 26
Saffran L, Ost DE, Fein AM, Schiff MJ. Outpatient pleurodesis of malignant pleural effusions using a small-bore pigtail catheter. Chest 2000;118:417-21.  Back to cited text no. 27
Musani AI, Haas AR, Seijo L, Wilby M, Sterman DH. Outpatient management of malignant pleural effusions with small-bore, tunneled pleural catheters. Respiration 2004;71:559-66.  Back to cited text no. 28
Van Meter ME, McKee KY, Kohlwes RJ. Efficacy and safety of tunneled pleural catheters in adults with malignant pleural effusions: A systematic review. J Gen Intern Med 2011;26:70-6.  Back to cited text no. 29
Putnam JB Jr., Light RW, Rodriguez RM, Ponn R, Olak J, Pollak JS, et al. A randomized comparison of indwelling pleural catheter and doxycycline pleurodesis in the management of malignant pleural effusions. Cancer 1999;86:1992-9.  Back to cited text no. 30
Davies HE, Davies RJ, Davies CW, BTS Pleural Disease Guideline Group. Management of pleural infection in adults: British Thoracic Society pleural disease guideline 2010. Thorax 2010;65 Suppl 2:ii41-53.  Back to cited text no. 31
Rahman NM, Maskell NA, Davies CW, Hedley EL, Nunn AJ, Gleeson FV, et al. The relationship between chest tube size and clinical outcome in pleural infection. Chest 2010;137:536-43.  Back to cited text no. 32
Maskell NA, Davies CW, Nunn AJ, Hedley EL, Gleeson FV, Miller R, et al. U.K. controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med 2005;352:865-74.  Back to cited text no. 33
Light RW. Pleural controversy: Optimal chest tube size for drainage. Respirology 2011;16:244-8.  Back to cited text no. 34
Lin YC, Tu CY, Liang SJ, Chen HJ, Chen W, Hsia TC, et al. Pigtail catheter for the management of pneumothorax in mechanically ventilated patients. Am J Emerg Med 2010;28:466-71.  Back to cited text no. 35
Kulvatunyou N, Joseph B, Friese RS, Green D, Gries L, O'Keeffe T, et al. 14 French pigtail catheters placed by surgeons to drain blood on trauma patients: Is 14-Fr too small? J Trauma Acute Care Surg 2012;73:1423-7.  Back to cited text no. 36
Yi JH, Liu HB, Zhang M, Wu JS, Yang JX, Chen JM, et al. Management of traumatic hemothorax by closed thoracic drainage using a central venous catheter. J Zhejiang Univ Sci B 2012;13:43-8.  Back to cited text no. 37


  [Table 1], [Table 2], [Table 3]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
   Results and Outcome
    Conclusion and A...
    Article Tables

 Article Access Statistics
    PDF Downloaded256    
    Comments [Add]    

Recommend this journal