2Procedure teams led by hospitalists are successfully being launched at many academic institutions around the country. Many of them have shown both direct and indirect benefits. Commonly offered procedures by these teams include thoracentesis, paracentesis, lumbar puncture, and central line insertion. To the best of our knowledge, pigtail chest tube insertion is not a commonly offered benefit of these services.
Our goal was to include ultrasound‐guided pig tail chest tube insertion as one of the procedures for our hospitalist led team, establish collaborative practice with cardiothoracic surgery, and study the impact of such procedures and as well as our co‐management with cardiothoracic surgery.
Our procedure team consists of a resident supervised by a hospitalist. We added pigtail chest tube placement as a service offered by our procedure team. Indications to consider chest tube insertion included large or recurrent effusions, pneumothorax, complicated parapneumonic effusion, and empyema. Inclusion criteria were all pigtail chest tube placements performed or supervised by procedure team between February and October of 2013. Exclusion criteria is all pigtail chest tube placements performed or supervised by other specialties. The pigtail catheters used in this study were Cook Wayne Pneumothorax 14 French©, Cook Fuhrman 8.5 French©, and variable size Cook multi‐purpose catheters©. The safety profile was measured by complications including pneumothorax, infection rate, hemothorax, organ injury, and death.
A collaborative practice agreement was established with cardiothoracic surgery. We would assist the cardiothoracic surgeons in performing ultrasound‐guided pigtail chest tube placement in their inpatient population, while the cardiothoracic surgeons would be immediately available for surgical care of any complications that occurred. Cardiothoracic surgery continued to manage the chest tube for their patients, while we managed them on patients that belonged to other service lines. We reserved the right to consult cardiothoracic surgery for management of chest tubes if needed.
Seventy‐eight ultrasound guided pigtail chest tube placements were performed at the patient’s bedside by our procedure team during the study period. Five were excluded due to supervision by pulmonary medicine. We observed a zero percent complication rate during this study. Fluid sample collection was requested in fifty‐two of these procedures and none were reported lost during transport. Three cases included a change in management after consulting cardiothoracic surgery; location of placement of pigtail chest tube, involvement of an additional posterior approach pigtail placement, and decision of using TPA.
We showed that bedside ultrasound‐guided pigtail chest tube placement is a safe procedure in the hands of well‐trained hospitalists. Collaborative practice with thoracic surgery provided improved patient safety and an expertise needed in complicated cases. Additionally, education of residents in both procedures and communication is greatly increased as a result of this practice. Future direction includes a more in depth cost analysis, including impact on decreased length of stay and increased availability of surgeons and interventional radiologists for other more complicated procedures, as well as patient and trainee satisfaction with bedside procedures.
To cite this abstract:Takahashi D, Rana V, Haasler G, Johnstone D, Fisher E, Kurman J, Reguero A. Impact of Bedside Ultrasound Guided Pigtail Chest Tube Placement: A Hospitalist Procedure Team‐Based Trial. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 233. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/impact-of-bedside-ultrasound-guided-pigtail-chest-tube-placement-a-hospitalist-procedure-teambased-trial/. Accessed July 23, 2019.