A treatment algorithm for pneumothoraces complicating central venous catheter insertion.
Am J Surg
; 180(6): 523-6; discussion 526-7, 2000 Dec.
Article
in En
| MEDLINE
| ID: mdl-11182411
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.CONCLUSION:
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.
Search on Google
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Pneumothorax
/
Catheterization, Central Venous
Type of study:
Observational_studies
/
Prognostic_studies
Limits:
Humans
Language:
En
Journal:
Am J Surg
Year:
2000
Type:
Article
Affiliation country:
United States