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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Friday, November 12, 2021

Pigtail in haemothorax

St Emlyn’s - By Simon Carley - November 11, 2021
“Back in 2016 we published a blog on chest drains and chest aspiration, in which we argued that the dogma of putting in huge drains for traumatic haemothoraces should be questioned. 
The dogma of using large drains has puzzled me for many reasons. One reason is that I also work in paediatric major trauma and there no way that I’m going to place a 36F drain in a 6 year old. Apart from anything else I’d probably have to remove a rib to do it, and yet the blood and air still comes out. Big drains might appear to be an obviously good choice for big volumes and maybe we think they clot less, but observational studies in trauma patients have suggested that smaller drains (28-32F vs 36-40F) may be just as effective. How small you can go is uncertain but 36-40F are pretty huge and I’ve stopped using them in my patients. Smaller than this and there is little evidence, but having worked in paeds and adults I’m pretty confident blood does come out of smaller tubes. Back in 2016 we found one study by Russo in swine that suggested 14F tubes may be OK, but it was a small animal study and we expressed caution in extrapolating that to clinical practice. 
This month we have new evidence from the US specifically looking at the 14F question in humans. The abstract is below, but as always we want you to read the full paper and make up your own mind.”