cc2447 CCJ Letter <p>Should central venous catheters be used to drain pleural effusions?</p> MacDuff Andrew Grant S Ian is.grant@luht.scot.nhs.uk

Locum Registrar Respiratory Medicine, Western General Hospital, Edinburgh, Scotland

Consultant Intensive Care Medicine, Western General Hospital, Edinburgh, Scotland

 Critical Care 1364-8535 2004 8 1 56 10.1186/cc2447 14975046 2 1 2004 2004 BioMed Central Ltd

We read with interest the article by Singh and coworkers 1 describing the use of central venous catheters to drain pleural effusions.

We agree that the use of small-bore catheters has a number of advantages compared with repeated thoracocentesis or the use of traditional large-bore drains inserted by blunt dissection. Indeed, recent guidelines 2 support the use of smaller bore tubes (8–14 Fr; except for haemothorax) in both pleural effusions and pneumothorax.

However, we have reservations regarding the routine use of central venous catheters to drain pleural effusions. Several manufacturers (including the Sims-Portex Seldinger Chest Drainage Kit and Cook Quick-Thal Chest Tube) have specific chest drainage systems that take advantage of the Seldinger dilator over a wire method of insertion. These have the advantage of having a number of side ports (two to four), which reduces the possibility of blockage by debris, and they are available in a range of sizes (8–36 Fr).

While we applaud innovation, in today's medico-legal climate it is surely wiser to use specifically designed equipment if it is available.

 <p>Pleural drainage using central venous catheters</p> Singh K Loo S Bellom R Crit Care 2003 7 R191 R194 10.1186/cc2393 14624695 374384 <p>BTS guidelines on the insertion of a chest drain</p> Laws D Neville E Duffy J on behalf of the British Thoracic Society Pleural Disease Group Thorax 2003 Suppl II ii53 ii59