Two-Year Experience of 14 French Pigtail Catheters Placed by Procedure-Focused Hospitalists

Over a 2-year period, the BPS was consulted to place 142 PCs. After resolution of the 3 discrepancies, total consults remained 142, PC attempts totaled 124 (87.3%), and declined consults totaled 18 (12.7%).

The 18 declined consults were not performed for reasons relating to procedural safety. These included 15 (83.3%) for insufficient fluid depth, 1 (5.6%) poor window for PTX, and 1 (5.6%) patient unstable per BPS attending judgement. One (5.6%) final consult had a previous drain in same hemithorax that resumed functioning.

The manual chart review of procedures performed 48 hours after declined PC consults found only 3 of 17 (17.6%) patients received a PC within the subsequent 48 hours. The 18th patient was unable to be followed in our electronic medical record because his medical record number was recorded incorrectly.

The remaining 124 consults were deemed safe for PC placement. Indications for PC placement varied; the most common indications were complicated effusion (36.3%), large or recurrent effusions (21.8%), PTX (17%), and hemothorax (HTX; 17%). The most common teams who consulted the BPS for PC were medicine/hospitalists (42.7%) and CT surgery (40.3%).

There were 3 IRCs (Table 2) out of 124 attempted consults (2.4%). Of these cases, 2 patients had AOs. IRC patient No. 1 required a PC for PTX and developed a hemothorax from a right-sided mammary artery laceration. Emergent operative measures were taken, but unfortunately the patient died. IRC patient No. 2 was septic from pneumonia when a PC was placed for a complicated PPE. Unfortunately, the patient went into respiratory failure and required intubation. The postintubation computed tomography scan did note that the PC placed by the BPS likely terminated in the lower lobe of the right lung but without PTX. After a new PC was placed by IR, the patient received antibiotics, 3 days of ventilator support, and was discharged home. The authors believe that sepsis from pneumonia was the more probable cause of the respiratory failure in IRC patient No. 2 instead of the PC placement.

Three UAs were charted in the database, but on review it was determined that only 2 (1.6%) qualified as UAs (Table 3). A PC was attempted with the UA patient No. 3 for a loculated apical PTX. It is clear in the procedure note that the pleural space was accessed, air was appropriately drained, and a PC was advanced safely into the pleural space; however, the PC then stopped draining air. CXR interpretation also noted “pneumothorax described on prior exam is less evident.” Because the pleural space was accessed safely and had a partially therapeutic response, we do not count this PC placement as a UA. The PC may count as “failed,” but determination of a “failure rate” is not the intent of this paper. This point is further discussed in the Discussion section.

In addition, chart review demonstrated that UA patient No. 3 required intubation within the 24-hour period after our PC attempt, which is an AO. Approximately 10 hours after our PC was placed and removed, CT surgery placed a second PC, and 3 hours after their PC placement, the patient was intubated with subsequent bronchoscopy. The patient was extubated after only 17 hours. This sequence of events suggests mucus plugging as a more likely cause for respiratory failure than our PC attempt, but we have included it as an AO given the time frame.

Overall, the AO rate was low. Out of 124 attempted PC placements only 3 (2.4%) had an AO, and as noted above, it is believed that 2 of these patients had an AO caused by other medical problems rather than by PC placement.