A pigtail catheter chest tube is a small, flexible medical device used to drain unwanted fluids or air from the space surrounding the lungs, known as the pleural cavity. This procedure helps the lungs re-expand and function properly. Its design allows for a less invasive approach compared to larger, traditional chest tubes, contributing to patient comfort and often a faster recovery.
What is a Pigtail Catheter Chest Tube?
A pigtail catheter is a small-bore, flexible tube that typically ranges in size from 6 to 18 French (Fr), with common sizes including 8, 8.5, 10, 12, and 14 Fr. The curled, “pigtail” shape at its distal end helps secure the catheter within the pleural cavity. This design also distributes pressure more evenly, potentially reducing irritation to the pleura.
These catheters are made of radiopaque materials like polyethylene, which allows them to be visible on X-ray imaging, confirming correct placement. The catheter features multiple side holes near its coiled tip for drainage of air or fluid. It connects to an external drainage system, often utilizing suction to remove the accumulated substances from the chest.
Conditions Treated by Pigtail Catheters
One common condition treated by pigtail catheters is pneumothorax, also known as a collapsed lung, which occurs when air leaks into the space between the lung and chest wall. Pigtail catheters remove this trapped air, allowing the lung to re-inflate.
Another frequent indication is pleural effusion, which involves a buildup of fluid around the lungs. This fluid can be thin (transudate) or thicker and contain inflammatory cells (exudate), resulting from various underlying medical conditions. Pigtail catheters drain this fluid, relieving pressure on the lungs and improving breathing.
Empyema, a more severe form of pleural effusion, involves the accumulation of pus in the pleural cavity, often due to infection. While pigtail catheters can be used for empyema, especially when guided by imaging, their effectiveness may vary with loculated (walled-off) collections of pus, which sometimes require additional interventions like thrombolytics or surgery. Draining these accumulations is necessary to prevent further respiratory compromise and manage infection.
The Insertion Procedure
Pigtail catheter insertion is a procedure often performed at the patient’s bedside or in an interventional radiology suite. Local anesthesia is administered to numb the skin and deeper tissues, including the parietal pleura, to minimize discomfort.
The procedure utilizes imaging guidance to precisely identify the fluid or air collection and determine the optimal insertion site. Imaging guidance allows the clinician to visualize the needle and catheter in real-time, helping to avoid injury to surrounding structures. A small incision is made, and the catheter is usually inserted using a Seldinger technique. The catheter is advanced until its side holes are fully within the pleural cavity, and then secured, often without the need for sutures.
Living with a Pigtail Catheter and Removal
While a pigtail catheter is in place, patients can expect a drainage system to be connected, which collects the fluid or air removed from the chest. The drainage bag should be kept below the level of the patient’s chest to facilitate gravity-assisted drainage. Regular monitoring of the drainage volume and characteristics is important, and the healthcare team will provide instructions on how to manage the system and when to report changes.
Patients may experience some pain at the insertion site, which can typically be managed with analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs) or, in some cases, local anesthetic injected through the catheter. Activity limitations might be advised to prevent dislodgement or kinking of the tube, which can obstruct drainage. It is important to watch for signs of potential complications, such as:
Increased pain
Redness or swelling around the insertion site
Fever (indicating infection)
Decreased drainage
Sudden shortness of breath
The small diameter of pigtail catheters means they can occasionally become kinked, twisted, or obstructed by clotted blood or thick fluid within the lumen. If the catheter stops draining or appears to be malfunctioning, additional imaging like a lateral chest X-ray or CT scan may be performed to confirm its position and patency. Once the lung has re-expanded and fluid or air drainage has significantly decreased or stopped, the pigtail catheter is typically removed. This removal is generally a quick and less painful process compared to larger chest tubes, and many patients experience less pain during removal than during insertion.