From the Guidelines
The best size chest tube in general is a small bore chest tube (14F or smaller), as recommended by the British Thoracic Society guideline for pleural disease 1. This size provides an optimal balance between effective drainage and patient comfort, minimizing morbidity, mortality, and improving quality of life. For specific conditions such as pneumothorax, hemothorax, or empyema, the size of the chest tube may vary, but the principle remains to use the smallest size that can effectively drain the pleural space while minimizing patient discomfort and trauma to the chest wall. Key considerations include:
- Using sterile technique and appropriate local anesthesia (1-2% lidocaine) when placing the chest tube 1
- Securing the tube properly with sutures and an occlusive dressing
- Connecting the tube to a drainage system with water seal and suction (typically -20 cm H2O) 1
- Selecting a chest tube size based on the specific clinical scenario, with the goal of achieving effective drainage while minimizing patient discomfort and trauma to the chest wall. It's also important to note that the use of small bore chest tubes has been shown to be effective in managing pneumothoraces, with primary success rates of 84-97% recorded in studies using drains of 7-9 F gauge 1.
From the Research
Chest Tube Size
The optimal chest tube size is a topic of debate, with various studies suggesting different sizes based on the specific clinical application.
- A study published in 2021 2 compared the efficacy of small (14 Fr) percutaneous catheters with large (28-32 Fr) open chest tubes in the management of traumatic hemothorax, and found that small caliber 14-Fr PCs are equally as effective as 28- to 32-Fr chest tubes.
- Another study from 2012 3 compared the efficacy of small (28-32 Fr) versus large (36-40 Fr) chest tubes in trauma patients, and found that chest tube size did not impact clinically relevant outcomes, including efficacy of drainage, rate of complications, and pain.
- A laboratory study from 2020 4 measured chest tube drainage in a controlled setting and compared measured flow rates to those predicted by the Hagen-Poiseuille equation, and found that the 28F chest tube exhibited a good balance of reasonable size and high flow rate, making it likely the optimal size for most clinical applications.
- Other studies 5, 6 provide general information on chest tubes and pleural drainage, but do not specifically address the optimal chest tube size.
Key Findings
- Small caliber chest tubes (14 Fr, 28 Fr) may be as effective as larger tubes (28-32 Fr, 36-40 Fr) in certain clinical applications.
- The optimal chest tube size may depend on the specific clinical scenario, such as traumatic hemothorax or pneumothorax.
- Further research is needed to determine the optimal chest tube size for different clinical applications.