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01.12.2018 | Original article | Ausgabe 1/2018 Open Access

The Ultrasound Journal 1/2018

An easier and safe affair, pleural drainage with ultrasound in critical patient: a technical note

The Ultrasound Journal > Ausgabe 1/2018
Luigi Vetrugno, Giovanni Maria Guadagnin, Daniele Orso, Enrico Boero, Elena Bignami, Tiziana Bove
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s13089-018-0098-z) contains supplementary material, which is available to authorized users.


Thoracic ultrasound is a powerful diagnostic imaging technique for pleural space disorders. In addition to visualising pleural effusion, thoracic ultrasound also helps clinicians to identify the best puncture site and to guide the drainage insertion procedure. Thoracic ultrasound is essential during these invasive manoeuvres to increase safety and decrease potential life-threatening complications. This paper provides a technical description of pigtail-type drainage insertion using thoracic ultrasound, paying particular attention to indications, contraindications, ultrasound guidance, preparation/equipment, procedure and complications.
Additional file 1: Video S1. Ultrasound allows for the visualisation of the vascular bundles, thus minimising the risk of damage to nerves and vessels. As shown, the intercostal neurovascular bundle is easily visible below the lower margin of the rib.
Additional file 2: Video S2. Ultrasound guidance allows the operator to decide where to insert the pigtail. The best puncture site is the place where the operator best visualises each anatomical structures (i.e., diaphragm, pleural, organs) and where the operator can measure the maximum distance between visceral and parietal pleural (increasing the safety margin). The probe should be used in the transverse position between two ribs. The probe marker is facing the patient’s head (on the right of the screen).
Additional file 3: Video S3. Check the position of the guidewire using thoracic ultrasound (TUS) before introducing the dilator. As shown, the guidewire is positioned correctly within the pleural effusion. The operator can insert the dilator.
Additional file 4: Video S4. The use of ultrasound allows identification of the best puncture site and for recheck, at all times, the correct position of the devices used. In this video, we can see all the procedure previously descripted.
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