Use of pigtail catheter and urosac: Numero uno for ambulatory chest drainage!

BACKGROUND: Intercostal chest drainage is required for varied lung diseases with the pleural involvement. While the conventional method of intercostal drainage (ICD) insertion with the bulky underwater drain (UWD) was the gold standard for management, it had numerous disadvantages. It was time and again challenged with better ambulatory methods, although the documentation and continued use of the same are rare in practice. We studied the efficacy of ambulatory chest drainage (ACD) with pigtail and urosac against the conventional drainage methods (ICD-UWD) at a tertiary care center.

MATERIALS AND METHODS: This prospective, observational study included the patients requiring chest drainage grouping them as per the intervention they underwent, i.e., (1) Pigtail-Urosac (ACD group) and (2) ICD-UWD (Non-ACD group). The clinical data were recorded and analyzed for the difference in the hospital stay, the total duration of drainage, successful outcome, residual disease, and pain in both groups using unpaired t-test and Chi-square test.

RESULTS: Of the 85 patients included in the study; 45 had pigtail-urosac and 40 had ICD-UWD, consisting of 34 pleural effusions and 51 pneumothoraces. The ACD and non-ACD groups were similar in etiology. Of the 85 patients, 50 had complete lung expansion, 18 pleural thickening, 15 loculated residual disease, and two pleurocutaneous fistulae. In the ACD group, the hospital stay was less as compared to the non-ACD group, i.e., 4.06 (4.42) versus 19.68 (31.39) days (P = 0.0008). The duration of chest drainage showed a similar trend, i.e., 19.29 (66.91) versus 52.18 (46.38) days (P = 0.006). Pain (P < 0.0001) recorded was significantly less with better expansion (P < 0.0001), less pleural thickening (P = 0.0067), and residual disease (P = 0.0087) in the ACD group.

CONCLUSION: The use of pigtail-urosac is a safe, effective, and preferred method for ACD.