What intercostal drainage tube size is appropriate for a healthy 2‑year‑old child (~10–15 kg)?

Intercostal Drainage Tube Size for a 2-Year-Old Child

For a 2-year-old child (~10-15 kg), use a small-bore chest drain of 8-12 French (FG), as these tubes are as effective as larger drains while minimizing patient discomfort and improving recovery. 1

Recommended Tube Size

• Small-bore drains (8-12 FG) should be used as the initial choice for intercostal drainage in a 2-year-old child, as there is no evidence that large-bore chest drains confer any advantage over smaller catheters. 1

• The majority of pediatricians now use smaller catheters (8-12 FG), and studies in adults have demonstrated these are as effective as larger bore tubes for drainage. 1

• Post hoc analysis from a UK multicentre study showed that small percutaneous catheters (mean size 10.5 FG) were associated with shorter hospital stays (geometric mean 7.2 vs 9.4 days) compared to larger surgical drains (mean size 20.1 FG). 1

Clinical Advantages of Small-Bore Drains

• Children are more comfortable and tolerate the procedure better with smaller soft drains (8-12 FG). 1

• Patients move more freely with smaller drains, which aids recovery and reduces complications. 1

• Small-bore drains including pigtail catheters should be used whenever possible to minimize patient discomfort. 1

When to Consider Larger Tubes

• Large-bore drains (20-24 FG) were historically used due to concerns about blockage by thick pus, but this has not been substantiated in clinical practice. 1

• If a small tube becomes blocked and cannot be unblocked by flushing, it should be removed and replaced if significant pleural fluid remains. 1

• The initial use of large (20-24 FG) intercostal tubes is not recommended, although it may become necessary to replace a small chest tube with a larger one if there is a persistent air leak. 1

Important Technical Considerations

• Small-bore percutaneous drains should be inserted at the optimum site suggested by chest ultrasound guidance. 1

• Neither substantial force nor a trocar should ever be used to insert a drain, as this risks sudden chest penetration and damage to intrathoracic structures. 1

• A chest radiograph must be performed after insertion to verify proper drain position and ensure all drainage holes are within the pleural cavity. 1, 2

• The Seldinger technique is commonly used for inserting small-bore drains in pediatric patients. 1