Since 1963, Cook Medical has been a champion of minimally invasive treatment options for patients. In the case of drainage procedural areas, the healthcare industry discussion has largely centred around the efficacy of large-bore versus small-bore catheters.
Several clinical studies and review articles published in peer-reviewed journals confirm the comparable efficacy between small-bore catheters and large-bore catheters for pleural drainage procedures.
| Study or Review | Small bore Fr size | Large bore Fr size | Conclusion |
|---|---|---|---|
| 1 | <14 | >14 | Small-bore catheter benefits include patient comfort and ease of placement. |
| 2 | <20 | >20 | Wire-guided, small-bore catheters cause substantially less pain without impairment in clinical outcome. |
| 3 | ≤16 | ≥16 | Small-bore catheters are shown to induce less pain. |
ARTICLE 1 (REVIEW)
In 2013, a paper published in Clinics in Chest Medicine aimed to generalise the use of small-bore catheters for drainage procedures, including in pleural infection.
In ‘Straightening out chest tubes: what size, what type, and when’, the authors state that ‘small-bore tubes (<14 Fr) are effective for most pleural processes. Various types of pneumothorax and malignant and infected complicated pleural effusions have been successfully managed with small-bore chest tubes.’1
Abundant literature supports a paradigm shift towards the more routine use of small-bore chest tubes for managing pleural disease.1
The authors also state that the benefits of using small-bore drainage catheters include patient comfort and ease of catheter placement.1
The study concludes that ‘abundant literature supports a paradigm shift towards the more routine use of small-bore chest tubes for managing pleural disease.’1
ARTICLE 2
A study published in CHEST, titled ‘The relationship between chest tube size and clinical outcome in pleural infection’, aimed to determine the optimal choice of drainage catheter sizes for pleural infection.
This multicentre study enrolled 405 patients and evaluated ‘the combined frequency of death and surgery, and secondary outcomes’, specifically ‘hospital stay, change in chest radiograph, and lung function at 3 months’, in patients who received a variety of sizes of chest tubes. In 128 of the 405 patients, a pain scale was also included.2
‘There was no significant difference in the frequency with which patients either died or required thoracic surgery in patients receiving chest tubes of varying sizes’, the study notes; however, ‘pain scores were substantially higher in patients receiving (mainly blunt dissection inserted) larger tubes’.2
The study concludes that ‘smaller, guide-wire-inserted chest tubes cause substantially less pain than blunt-dissection-inserted larger tubes, without any impairment in clinical outcome in the treatment of pleural infection.’2
ARTICLE 3 (REVIEW)
Although the precise optimal chest drain size remains unknown, a review article titled ‘Optimal chest drain size: the rise of the small-bore pleural catheter’, published in Seminars in Respiratory and Critical Care Medicine, asserts that ‘objective data supporting the use of large-bore [chest] tubes is scarce in most pleural disease’.3
In support of the efficacy of small-bore drains, the article states, ‘Increasing evidence shows that small-bore catheters induce less pain and are of comparable efficacy to large-bore tubes, including in the management of pleural infection, malignant effusion, and pneumothoraces.
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1. Mahmood K, Wahidi MM. Straightening out chest tubes: what size, what type, and when. Clin Chest Med. 2013;34(1):63-71.
2. Rahman NM, Maskell NA, Davies CW, et al. The relationship between chest tube size and clinical outcome in pleural infection. Chest. 2010;137(3):536-543.
3. Fysh ET, Smith NA, Lee YC. Optimal chest drain size: the rise of the small-bore catheter. Semin Respir Crit Care Med. 2010;31(6):760-768.