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Abstract

Introduction The objective of the present study was to evaluate the use of a single lumen 16 G central venous catheter for the drainage of uncomplicated pleural effusions in intensive care unit patients. Methods A prospective observational study was performed in two intensive care units of university-affiliated hospitals. The study involved 10 intensive care unit patients with non-loculated large effusions. A 16 G central venous catheter was inserted at the bedside without ultrasound guidance using the Seldinger technique. The catheter was left in situ until radiological resolution of the effusion. Results Fifteen sets of data were obtained. The mean and standard deviation of the volumes drained at 1, 6 and 24 hours post catheter insertion were 454 ± 241 ml, 756 ± 403 ml and 1010 ± 469 ml, respectively. The largest volume drained in a single patient was 6030 ml over 11 days. The longest period for which the catheter remained in situ without evidence of infection was 14 days. There were no instances of pneumothorax, hemothorax, re-expansion pulmonary edema and catheter blockage/ disconnections. Conclusions The use of an indwelling 16 G central venous catheter is efficacious in draining uncomplicated large pleural effusions. It is well tolerated by patients and is associated with minimal complications. It has the potential to avoid repeated thoracentesis or the use of large-bore chest tubes.

Utility and safety of draining pleural effusions in mechanically ventilated patients: a systematic review and meta-analysis

“…The 19 included studies are summarized in Table 1 ; the authors of three studies provided additional information [ 4 , 31 , 32 ]. Four studies measured physiological effects of pleural drainage [ 31 , 33 - 35 ]; seven studies assessed the safety of thoracentesis [ 36 - 42 ]; and three studies assessed the accuracy of ultrasonographic prediction of pleural effusion size [ 43 - 45 ]. Four studies employed real-time ultrasound guidance [ 32 - 34 , 46 ] and eight studies employed ultrasound to mark the puncture site for thoracentesis [ 36 , 38 - 41 , 43 , 45 , 47 ].…”

“…The mean age of enrolled patients ranged from 35 to 74 years. Of 494 patients in six studies reporting the type of effusion [ 4 , 31 , 34 , 40 , 42 , 46 ], 42% were classified as exudative, 55% transudative (as defined in each study), and the remaining 3% had indeterminate biochemical findings.…”

Management of traumatic hemothorax by closed thoracic drainage using a central venous catheter

“…Moreover, the indwelling time was similar in successfully treated patients in both groups. If catheter obstruction does occur, it can be cleared by simply rinsing with physiological saline or, even more effectively, by using the guide wire supplied with the catheter (Shang and Lou, 2001;Singh et al, 2003). In contrast, obstructed chest tubes are difficult to clear, and patients can be treated only by replacing the catheter/tube or by repeated puncture tapping.…”

“…Although the drainage speed of a CVC is slower than that of a chest tube, we found that a CVC was still able to drain >1 000 ml of effusion fluid per hour in large hemothorax cases. Singh et al (2003) used CVCs to drain pleural effusions in 15 patients and recorded a mean drainage volume of (454±241) ml in the first hour after catheterization, substantially higher than 200 ml/h. This suggests that use of an unobstructed CVC would not hinder the identification of progressive hemothorax.…”

Pleural Effusions in Critically Ill Patients

“…Moreover, a central venous catheter inserted using a Seldinger technique may be efficacious, well tolerated and with minimal complications in draining uncomplicated large PEs [57]. …”