COMPARISON OF SMALL VERSUS LARGE BORE CHEST DRAIN COMPLICATIONS IN THE MANAGEMENT OF MALIGNANT PLEURAL EFFUSION

ABSTRACT
Background: A pleural effusion is defined as the accumulation of abnormal volumes of fluid in the pleural space.
Malignancies contribute to 22% of pleural effusion. Chest tubes are used to drain air or fluid from pleural space. This
study was conducted to compare complications of small versus large bore chest drain in the management of malignant
pleural effusion.
Methods: this randomized controlled trial was conducted in the Pulmonology and Cardiology wards/OPD’s of Khyber
Teaching Hospital, Peshawar in which 80 patients were divided equally into two groups, A and B, by non-probability
sampling and were subjected to Small Bore Chest Drain (SBCD) and Large Bore Chest Drain (SLBCD) for effusion
drainage. All patients of either gender with malignant pleural effusion were included in the study. Patients with malignant
effusion who were terminally ill or having bleeding diathesis, Immunocompomised, diabetics, benign pleural effusions,
hydro pneumothorax and empyema were excluded. All patients with pleural effusion were subjected to pleural aspiration
and pleural biopsy. Cytology and histopathology was done to diagnose malignant pleural effusion.
Results: Mean SD of Age for Group A (SBCD) was 44.90+15.55 and Mean SD of Age for Group B (LBCD) was recorded
as 45.83+15.65. Out of 80 total patients 60 (75%) were male and 20(25%) were female. Overall complications of both
groups were only 30% which included 2(5%) pain in Group A (SBCD) as compare with 6(15%) in Group B (LBCD).
Drain blockage took place in 8 (20%) patients in Group A (SBCD) as compare with 2 (5%) in Group B (LBCD). Drain
dislodgement was in 4 (10%) patients of Group A (SBCD) as compare to 2 (5%) in Group B (LBCD).
Conclusion: As small bore chest drains are easy to insert, less painful and have comparable complications to large
bore chest drain, with frequent drain washing can be used in the management of malignant effusion. Small bore chest
drain is well tolerated by patients.
Keywords: Malignant pleural effusion, chest drain.