We read with interest the article by Singh and coworkers [1] describing the use of central venous catheters to drain pleural effusions.
We agree that the use of small-bore catheters has a number of advantages compared with repeated thoracocentesis or the use of traditional large-bore drains inserted by blunt dissection. Indeed, recent guidelines [2] support the use of smaller bore tubes (8–14 Fr; except for haemothorax) in both pleural effusions and pneumothorax.
However, we have reservations regarding the routine use of central venous catheters to drain pleural effusions. Several manufacturers (including the Sims-Portex Seldinger Chest Drainage Kit and Cook Quick-Thal Chest Tube) have specific chest drainage systems that take advantage of the Seldinger dilator over a wire method of insertion. These have the advantage of having a number of side ports (two to four), which reduces the possibility of blockage by debris, and they are available in a range of sizes (8–36 Fr).
While we applaud innovation, in today's medico-legal climate it is surely wiser to use specifically designed equipment if it is available.
References
- Singh K, Loo S, Bellom R. Pleural drainage using central venous catheters. Crit Care. 2003;7:R191–R194. doi: 10.1186/cc2393. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Laws D, Neville E, Duffy J, on behalf of the British Thoracic Society Pleural Disease Group BTS guidelines on the insertion of a chest drain. Thorax. 2003;Suppl II:ii53–ii59. doi: 10.1136/thorax.58.suppl_2.ii53. [DOI] [PMC free article] [PubMed] [Google Scholar]