Pigtail Catheter Placement (Small-Bore Thoracostomy)
[Ultrasound-guided / Landmark-guided] [right / left] pigtail catheter thoracostomy, [X] Fr
[Right / Left] [pneumothorax / hemothorax / pleural effusion] requiring small-bore catheter drainage.
[Informed consent was obtained from the [patient / patient's surrogate] after discussion of risks, including bleeding, infection, lung or abdominal organ injury, and the need for a larger tube, as well as benefits and alternatives / The procedure was emergent, and consent was implied].
[***, MD/DO]
Local: [X] mL 1% lidocaine
[Air / [X] mL of [serous / serosanguineous / bloody / purulent] fluid] was evacuated. Post-procedure chest radiograph showed the catheter in the pleural space with [lung re-expansion / decreased effusion].
A time-out was completed confirming the patient, procedure, and side. The patient was positioned [supine with the arm abducted / sitting upright], and the [4th to 5th intercostal space at the anterior axillary line / 4th to 5th intercostal space at the mid-axillary line / 2nd intercostal space at the midclavicular line] was selected [with ultrasound / by landmarks]. The site was prepped with chlorhexidine and draped, and [X] mL of 1% lidocaine was infiltrated down to the rib and parietal pleura.
The needle was advanced over the superior border of the rib with aspiration until [air / fluid] returned. A guidewire was passed, a skin nick was made with an #11 blade, and the tract was dilated. The [X] Fr pigtail catheter was advanced over the wire, and the wire was removed. The catheter was connected to [-20 cmH2O suction / water seal / a Heimlich valve] and secured to the skin with [a suture / a securement device], and an occlusive dressing was applied.
[X] Fr pigtail catheter, [right / left] pleural space, secured with [a suture / a securement device], to [-20 cmH2O suction / water seal / a Heimlich valve]
Minimal
[None / Pleural fluid for cell count, pH, glucose, LDH, protein, Gram stain and culture[, and cytology]]
None
The patient tolerated the procedure well. Catheter output and air leak will be monitored, and the catheter will be removed when [the air leak has resolved and the lung remains expanded / output is less than [X] mL per day].
Epic SmartPhrase Version
PROCEDURE: [Ultrasound-guided / Landmark-guided] [right / left] pigtail catheter thoracostomy, *** Fr
INDICATION: [Right / Left] [pneumothorax / hemothorax / pleural effusion] requiring small-bore catheter drainage.
CONSENT: [Informed consent obtained from the [patient / surrogate] after discussion of risks, including bleeding, infection, lung or abdominal organ injury, and need for a larger tube, benefits, and alternatives / Emergent, consent implied].
PERFORMED BY: ***, MD/DO
ANESTHESIA: Local: *** mL 1% lidocaine
FINDINGS: [Air / *** mL of *** fluid] evacuated. Post-procedure CXR: catheter in the pleural space, [lung re-expanded / effusion decreased].
PROCEDURE DETAILS:
Time-out completed. Positioned ***. *** intercostal space, *** line, selected [with ultrasound / by landmarks]. Prepped with chlorhexidine and draped. *** mL 1% lidocaine to the rib and parietal pleura. Needle advanced over the superior rib border with aspiration until [air / fluid] returned. Guidewire passed, skin nick with #11 blade, tract dilated. *** Fr pigtail advanced over the wire, wire removed. Connected to [-20 cmH2O suction / water seal / Heimlich valve]. Secured to skin, occlusive dressing applied.
DEVICE PLACED: *** Fr pigtail catheter, [right / left] pleural space, secured with ***, to ***
EBL: Minimal
SPECIMENS: [None / Pleural fluid for cell count, pH, glucose, LDH, protein, Gram stain and culture]
COMPLICATIONS: None
POST-PROCEDURE PLAN: Tolerated well. Output and air leak to be monitored. Catheter to be removed when [air leak resolved and lung expanded / output less than *** mL/day].
Signed: .ME, .MYDEGREE
.TODAYVariants
Complicated Parapneumonic Effusion / Empyema (Intrapleural tPA and DNase)
Intrapleural alteplase 10 mg and dornase alfa 5 mg, each diluted in [X] mL of normal saline, were instilled [sequentially / together] through the catheter. The catheter was clamped for 1 hour after each instillation and then returned to drainage. The planned course is twice daily for 3 days.
Charting Tips
- State whether ultrasound or landmarks guided placement, and save an image when ultrasound is used. Ultrasound does not show the pleural space through a pneumothorax. It shows absent lung sliding.
- Confirm on the chest radiograph that every side hole is inside the pleural space. A side hole in the chest wall causes subcutaneous emphysema or poor drainage.
- Small-bore catheters (14 Fr or smaller) suit most pneumothoraces, free-flowing effusions, and hemothorax in hemodynamically stable trauma patients. Use a large-bore tube for hemodynamic instability, massive hemothorax, or a large air leak.
- For a parapneumonic effusion, record pleural pH and glucose. A pH below 7.20 or glucose below 60 mg/dL indicates a complicated effusion that needs drainage.
Documentation & Reimbursement Considerations
- Primary service: Report Pigtail Catheter Placement (Small-Bore Thoracostomy) as the primary service when it is the definitive operation performed.
- Placement with and without imaging guidance is reported with different codes. State whether ultrasound or CT guidance was used. The guidance is included in the placement and is not reported separately.
- 0-day global: no bundled postoperative period. Later catheter manipulation or exchange may be separately reportable with appropriate documentation.