Medical Chest Drain Insertion – Considerations for a Pleural Service

Aim: To review local chest drain insertions, the indications, use of fibrinolytics, and the success rate of talc pleurodesis in a tertiary hospital in New Zealand. Methods: This is an observational study of all patients requiring chest drain insertion in the respiratory unit in Christchurch Hospital from January 2015 to December 2016. We analysed patient characteristics, type of drain inserted, and the nature of pleural fluid. We report the success of fibrinolytic therapy for empyema and pleurodesis for malignant pleural effusions. Results: A total of 486 chest drains were inserted for 333 patients, with a median age of 69 years. The majority of patients were male (60%) and 259 drains (53.3%) were inserted on the right. The main indications for chest drain insertion were malignant pleural effusions (50.5%), non-malignant pleural fluid (33.6%) and pneumothorax (17.7%). Most drains inserted were of small caliber; they were 12 French (Fr) (62.4%), central venous catheters to drain the pleural space (14.2%), and indwelling pleural catheters (10.9%). Talc slurry pleurodesis for malignant pleural effusions was used in 40 cases with a success rate of 75%. In the 41 cases of empyema and complicated parapneumonic effusions (CPE), 29 organisms were cultured. The majority of organisms identified were Streptococcus and Staphylococcus species. Fibrinolytics were used in 26 cases (52%) of empyema and CPE. Of the 22 patients who required surgical intervention, only two had prior fibrinolytic therapy for empyema / CPE. Conclusion: Small bore catheters were used in Christchurch in keeping with international guidelines. The success rate of talc slurry pleurodesis and fibrinolytic therapy was in keeping with international experience.