Controlled pneumothorax for percutaneous thoracic biopsy and ablation

Abstract

Learning Objectives: We describe how to read a water seal device (WSD) and present an algorithm for management of patients with chest tubes placed following percutaneous lung biopsy (PCLB) for pneumothorax. Background: Chest tubes are placed following PCLB for management of iatrogenic pneumothorax in approximately 2 -15% of cases (1). Algorithms for chest tube management of pneumothorax in the literature typically utilize repeat chest radiography to determine when a chest tube can safely be removed (2,3,4). As a WSD provides real-time physiologic information about the pleural space, it can be utilized as an alternative or supplement to chest radiography to determine when chest tube removal is appropriate and identify those patients that may be safely discharged home the day of biopsy. Clinical Findings/Procedure Details: A WSD is a one-way valve that allows air to leave but not re-enter the pleural space. Reading a WSD for pneumothorax involves three key components, evaluating for air leak, assessing intrathoracic pressures and determining if normal tidaling is occurring. We utilize an algorithm for chest tube management which is initially centered around interpreting a WSD to determine which patients can have their chest tube removed the same day of biopsy, those that can be discharged with outpatient management and patients who require admission for further monitoring. Strict criteria are used to determine which patients can be safely discharged with a post-PCLB pneumothorax including proximity to the hospital, reliable transportation and roads, supervision, telephone access, normal contralateral lung, normal baseline lung function (FEV 450 and not on home O2), limited patient anxiety and pain control (5,6). Conclusions: Appropriate use of a WSD can reduce patient radiation exposure and expedite same day discharge of patients that require chest tube placement for pneumothorax following PCLB.