{'fraction_non_alphanumeric': 0.02639963586709149, 'fraction_numerical': 0.012744651797906235, 'mean_word_length': 5.620481927710843, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Chest drains: does size matter?

Received: 20 August 1999 Accepted: 22 September 1999Hippocrates ﬁrst advocated pleural drainage 2400 years agowhen he described the use of incision, cautery and metal tubesto treat empyema [1]. The technique became widely usedduring the inﬂuenza epidemic of 1917 to drain post-pneumonicempyema [2]. In recent years, large-bore drains have been themainstay of treatment for percutaneous drainage of pleuralcollections and they remain in use for post-surgical thoracicdrainage. Indications for tube placement within the chestinclude pneumothorax, benign and malignant pleural effusion,parapneumonic effusion and empyema, and haemothorax.Traditional surgical teaching dictates that viscous ﬂuid collec-tions require large tubes for successful drainage [3,4]. Recentpublications suggest that a variety of pleural collections can beadequately drained using small-bore catheters, often insertedunder imaging guidance, avoiding the complications associatedwith the ‘blind’ insertion of large-bore chest tubes. It is likelythat the evidence supporting the use of small-bore drains withinthe abdomen and pelvis may be applicable in the chest. It is alsopossible, but perhaps less likely, that dissemination of thisevidence may end the not infrequent assertion by clinicians thatpatients ‘would have been better treated with a bigger drain’.FACTORS INFLUENCING SUCCESSFUL DRAINAGEFor a ﬂuid or air collection to be drained successfully thedraining catheter needs to be of sufﬁcient bore to allowadequate ﬂow, to remain patent and for all or the majority ofthe collection being drained to be in communication with thecatheter. It is also desirable to use the catheter that is the safestand most comfortable for the patient. A large-bore catheterwould appear to fulﬁl the ﬁrst two criteria best. However,review of the published evidence suggests that small-borecatheters are at least as effective as large-bore tubes, implyingthat other factors need to be considered. The distinctionbetween a small and large-bore catheter is entirely arbitrary;for the purposes of this discussion we regard drains of up toand including 14-French (F) as small-bore, and above 14F aslarge-bore.