Seldinger technique for pigtail intercostal catheter insertion

[RMM]

Hi All

I just had a question regarding the insertion of pigtail intercostal catheters using the seldinger technique. Our unit currently doesn't use pigtail catheters for ICC and we use the traditional method of blunt dissection down to the parietal pleura then entering the pleural space using curved forceps. Some of the Neonatologists in our unit do use the trochar that comes with the intercostal catheters to enter the pleural space. Our PICU colleagues have recently commented about the this technique and the problems they have found with air leaking around the entry site despite adequate securing of the catheter and dressings. They have suggested we switch to using pigtail catheters especially in our bigger babies and I am just curious about others experience. This would obviously require some upskilling and training of the staff in the unit and I was also wondering if anyone had any good instructional videos available detailing the pigtail catheter insertion using the Seldinger technique in the neonatal population.

Any comments or suggestions would be useful!

Many thanks

RichMaus

[Stefan Johansson]

For preterms we use a pigtail that is 6Fr that is very easy to use.

I think Cook does also thicker drains like 8Fr but for larger babies we use Vygon Easydrain, also very handy. 

I am work now, and took a few pictures, I guess you can find imagen on the web on the actual drains (not packed up  )

I have used a seldinger techn drain a few times but have felt the insertion to be quite "wonky"

(OT I posted this on my phone, the mobile interface works great 👍)

[drjasims]

We use the pigtail catheters in our unit. I have found it to be less traumatic and easy to secure. I ll post pictures tomorrow of the drains.

[anja stein]

We also use the Seldinger technique with pigtail catheters, much less traumatic, almost no scar, easy to learn. For premies we use 6Fr, 8 Fr for older children is also available. Not only for pneumothorax but also effective for pleural effusions. Complete sets are available.

[Stefan Johansson]

@anja stein What brand are you using? 

[chandas]

Not an instructional video but a picture booklet that we have developed locally as our guideline. Can't attach the guideline here due to it size but you should be able to access it by following think link (https://dl.dropboxusercontent.com/u/4701858/Pigtail Chest Drain insertion.pdf)

[RMM]

@chandas that is extremely useful-thank you for sharing that. I suppose it would be relatively easy to make a VOLT using a manikin. What brand are you using? 

[RMM]

I was wondering if anyone had come across any evidence for the use of pigtail catheters and/or Seldinger technique for the insertion of intercostal catheters in the Neonatal population?

@chandas - I was also just wondering what product brand you use? Does it comes as a set? Thanks

[coarc]

The company reps., clinicians have held classes for our NNP's and new Fellows.

[spartacus007]