title: A treatment algorithm for pneumothoraces complicating central venous catheter insertion.
abstract: BACKGROUND
  We investigated the role of observation or insertion of a small French pigtail catheter with Heimlich valve as alternative management to a tube thoracostomy for iatrogenic pneumothorax complicating central venous catheter (CVC) insertion.
  
  
  METHODS
  A retrospective review of 9,637 consecutive patients who had had subclavian CVCs inserted on an outpatient basis identified 100 patients with pneumothoraces. Treatment consisted of (1) observation, (2) outpatient insertion of a Heimlich valve, or (3) inpatient tube thoracostomy.
  
  
  RESULTS
  The median pneumothorax size was 10% (range 1% to 100%). Fifty-eight patients had observation as initial treatment, and this strategy was successful in 35 (60%). Thirty-four patients were treated initially with Heimlich valves, and this strategy was successful in 29 (85%). Tube thoracostomy as initial therapy was successful in 7 (88%) of 8 patients. Patients in who initial treatment failed were treated with insertion of a Heimlich valve or tube thoracostomy.
  
  
  CONCLUSIONS
  In appropriately selected patients, pneumothorax after insertion of a subclavian CVC can be successfully managed in the outpatient setting with observation. Patients in whom observation fails can be treated with insertion of a Heimlich valve. Tube thoracostomy can be reserved for refractory PTX or emergent situations.
authors.affiliation: Department of Surgical Oncology, the University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: C
authors.initials: C
authors.lastname: Laronga
authors.forename: F
authors.initials: F
authors.lastname: Meric
authors.forename: M T
authors.initials: MT
authors.lastname: Truong
authors.forename: C
authors.initials: C
authors.lastname: Mayfield
authors.forename: P
authors.initials: P
authors.lastname: Mansfield
mesh_terms: D000553:Ambulatory Care; D002404:Catheterization; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D006801:Humans; D011030:Pneumothorax / Q000209:etiology* / Q000628:therapy*; D012189:Retrospective Studies; D013350:Subclavian Vein; D013907:Thoracostomy