The use of small-bore wire-guided chest drains for the management of feline pyothorax: A retrospective case series

Abstract

Background: Pyothorax in cats is routinely managed, at least initially, with thoracic tube placement associated with systemic antimicrobial administration. Traditionally, large-bore trocar-type thoracostomy tubes have preferentially been used for the drainage of thick material from the pleural space. In recent years, the use of small-bore wire-guided thoracic drains has increased in both small animals and in humans. Few studies have highlighted the efficacy of smallbore wire-guided thoracostomy tubes.Aim: The purpose of this study was to describe the use of small-bore wire-guided thoracostomy tubes in feline pyothorax in terms of efficacy, safety, and outcome.Methods: Cats with pyothorax managed with small-bore thoracostomy tubes (SBTTs) (2015–2018) were retrospectively studied. The number of drains inserted, the need for anesthesia and analgesia for chest tube placement and maintenance, and related major and minor complications were reviewed. Clinical data, diagnostic results, treatment, and outcome were recorded.Results: Ten cats were enrolled. Thoracostomy tube placement was unilateral in 7/10 cats, despite the presence of bilateral effusion in 9/10 cats, and required sedation (8/10) or anesthesia (2/10). Three cats experienced minor complications during the chest tube insertion, including self-limiting pneumothorax (1/3) and malpositioning (2/3). One cat had a major complication (non-functional malposition) requiring reposition of the drain. Pain management was adequately achieved using opioids (8/10) or opioids plus nonsteroidal anti-inflammatory drugs (2/10). Partialchest tube occlusion occurred in three cases and it was resolved with lavage. In one case, the occlusion was complete, requiring drain removal. Three out of 10 cats were treated medically, combining thoracostomy tubes and antibiotics, while 7/10 cats underwent surgery. All the cats survived.Conclusion: SBTTs represent a safe and effective option for the initial management of feline pyothorax. In fact, mainly minor complications were reported during insertion and usage. The SBTTs were well tolerated by the cats with a satisfactory performance in terms of exudate drainage in most cases. The combined use of a small-bore thoracostomy drain together with the common practice of surgical treatment might have resulted in the successful management of the cases presented.

Retrospective Evaluation of the Use and Complications of Small-Bore Wire-Guided Thoracostomy Tubes in Dogs and Cats: 156 Cases (2007–2019)

“…However, a canine cadaver study showed no difference in removal of air or low- or high-viscosity fluid between large- and small-bore thoracostomy tubes ( 17 ). This further confirms clinical reports of successful management of pyothorax in dogs and cats with SBWGTT ( 7 , 15 ). Despite the wide use of SBWGTT in dogs and cats for the last decade, limited information exists about associated indications and complications.…”

“…One case died prior to surgery due to development of septic shock and the second required a lung lobectomy of the perforated lung lobe. Accidental lung perforation with the insertion of the SBWGTT is not previously reported in the previous literature in veterinary medicine ( 6 , 7 , 15 ). Accidental lung laceration associated with placement of thoracostomy tubes is reported in human medicine ( 18 – 20 ).…”

“…In veterinary medicine, the most commonly used thoracostomy tubes include the traditional trocar type, small-bore wire-guided thoracostomy tubes (SBWGTT), and recently Jackson Pratt thoracostomy drains ( 4 – 6 ). The larger-bore trocar types have traditionally been used for the drainage of dense and thick material from the pleural space ( 7 ). Placement requires general anesthesia, and substantial training is required prior to first insertion.…”

Therapy of Pyothorax in Cats via Small-Bore Thoracostomy Tube in Terms of Efficacy, Complications and Outcomes

“…In addition, the needle has a larger outer diameter (10 F) than the tube (8 F), which may promote subcutaneous fluid leakage. A wire-guided technique is described for small-bore tubes (6 F) in 2 case series of cats with pyothorax ( n = 8 [ 8 ] and n = 10 [ 9 ]). These tubes can be placed under sedation using an introducer needle (14 Ga or 18 Ga included in the kit) and a 0.035 inch guidewire [ 8 ].…”

“…In addition to the classical large-bore tubes, the use of a 10 F trocar-based thoracostomy tube placed under general anaesthesia is published [ 3 ]. Alternatively, the use of a small-bore (6 F) wire-guided thoracostomy tube is reported in 2 case series of cats with pyothorax [ 8 , 9 ]. The most common complication with these small-bore tubes is a failure to drain, as a result of kinking [ 8 ].…”