Background and aim of the study : Tube thoracostomy remains the standard of care for the treatment of pneumothorax and simple effusions in most hospitals (2, 8). Placement of a large-bore chest tube is an invasive procedure with potential morbidity and complications and therefore the use of small-bore catheter may be desirable (3). The objective of this study was to evaluate the efficacy and complications of using small-bore catheters (8.3-12 fr.) in drainage of pleural effusion as a less invasive alternative to traditional chest tube insertion.

Patients and methods:   This prospective study was conducted between January 2010 and september 2012, At Sohag university hospital, El-Helal Inssurance hospital in Sohag, and Qena university hospital (tertiary hospitals in upper Egypt). We evaluated the efficacy and safety of small-bore catheters (8.5–12 French) insertion in cases of pleural effusion of various etiologies. Two hundred and sixty (260) small-bore catheters were placed in 241 patients. Mean age was 48.4 years (18 to 77 years). There were 152 males and 89 females.  The reasons for small-bore catheter drainage were: malignant effusion (n=61), parapneumonic effusion (n=33), transudative effusion (n=46), exudative effusion (hepatic failure and renal failure) (n=68), T.B effusion (n=11), traumatic hemothorax (n=14), and postoperative (n=27).

Results: Duration of drainage of pleural fluid was 2-15(mean=6.9) days. The Overall success rate was 82.3%. The success rate was highest when the drain was used to treat massive transudate effusions (86.9%) and exudative (post renal and hepatic failure) pleural effusions (83.8%), followed by malignant effusions (82%), T.B. effusion (81.8%), then post operative effusion (81%), parapneumonic pleural effusion (75.7%), and finally post traumatic hemothorax which yielded the lowerist incidence of success (10 out of 14, 71%).  Among the eight cases of empyema, the procedure was successful only in five of them (success rate 37.3%). There were no major complications related to catheter insertion. Complications included pain at the insertion site requiring analgesia in 38 patients (14.6%), pneumothorax in 72 (27.6%) patients, failure to drain properly in 60 patients (23%), fever in 10 cases, and infection in 3 patient (1%). 46 out of 260 catheter placements were not successful, 16 due to loculated effusions, 17 due to obstruction and blockage of the catheter, 5 cases with advanced parenchymatous lung disease, and 5 due to rapid re-accumulation of the fluid after removal of the catheter. If the cases of loculated pleural effusions and advanced lung disease are excluded, the success rate increases to 90% (235 out of 260).        

Conclusion:  Small-bore catheter insertion is an effective and safe method for draining pleural fluid of most etiologies. We recommend its use for all cases of pleural effusion requiring chest drain except for hemothorax, empyema and other loculated pleural effusions that yield low success.