title: 14 French pigtail catheters placed by surgeons to drain blood on trauma patients: is 14-Fr too small?
abstract: BACKGROUND
  Small 14F pigtail catheters (PCs) have been shown to drain air quite well in patients with traumatic pneumothorax (PTX). But their effectiveness in draining blood in patients with traumatic hemothorax (HTX) or hemopneumothorax (HPTX) is unknown. We hypothesized that 14F PCs can drain blood as well as large-bore 32F to 40F chest tubes. We herein report our early case series experience with PCs in the management of traumatic HTX and HPTX.
  
  
  METHODS
  We prospectively collected data on all bedside-inserted PCs in patients with traumatic HTX or HPTX during a 30-month period (July 2009 through December 2011) at our Level I trauma center. We then compared our PC prospective data with our trauma registry-derived retrospective chest tube data (January 2008 through December 2010) at our center. Our primary outcome of interest was the initial drainage output. Our secondary outcomes were tube duration, insertion-related complications, and failure rate. For our statistical analysis, we used the unpaired Student's t-test, χ test, and Wilcoxon rank-sum test; we defined significance by a value of p < 0.05.
  
  
  RESULTS
  A total of 36 patients received PCs, and 191 received chest tubes. Our PC group had a higher rate of blunt mechanism injuries than our chest tube group did (83 vs. 62%; p = 0.01). The mean initial output was similar between our PC group (560 ± 81 mL) and our chest tube group (426 ± 37 mL) (p = 0.13). In the PC group, the tube was inserted later (median, Day 1; interquartile range, Days 0-3) than the tube inserted in our chest tube group (median, Day 0; interquartile range, Days 0-0) (p < 0.001). Tube duration, rate of insertion-related complications, and failure rate were all similar.
  
  
  CONCLUSIONS
  In our early experience, 14F PCs seemed to drain blood as well as large-bore chest tubes based on initial drainage output and other outcomes studied. In this early phase, we were being selective in inserting PCs in only stable blunt trauma patients, and PCs were inserted at a later day from the time of the initial evaluation. In the future, we will need a larger sample size and possibly a well-designed prospective study.
  
  
  METHODS
  Therapeutic study, level V.
authors.affiliation: Department of Surgery, Division of Trauma, University of Arizona, Tucson, Arizona. nkulvatunyou@surgery.arizona.edu
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.forename: Donald
authors.initials: D
authors.lastname: Green
authors.forename: Lynn
authors.initials: L
authors.lastname: Gries
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Andy L
authors.initials: AL
authors.lastname: Tang
authors.forename: Julie L
authors.initials: JL
authors.lastname: Wynne
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000295:instrumentation; D015505:Chest Tubes; D004322:Drainage / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006491:Hemothorax / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000628:therapy*; D014193:Trauma Centers; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult