Insertion distance of neonatal intercostal catheters using a 10 French Argyle trocar thoracic catheter.

OBJECTIVE We believed that intercostal catheters were often inserted too far into the thoracic cavity in neonatal patients. The aim of this study was to determine the average distance from the catheter tip to the midline, of intercostal catheters inserted in our neonatal unit and the incidence of catheters that were inserted too far into the thoracic cavity. METHODS During a two year period we examined the chest X-rays of all infants who had an intercostal catheter inserted using an Argyle 10 French trocar thoracic catheter for drainage of a pneumothorax. For each initial chest X-ray following the insertion of the intercostal catheter we measured the horizontal distance in mm from catheter tip to the midline. The tip to midline distance was zero if the tip was at the midline and negative if it crossed the midline. To standardise the tip to midline distance for different size infants we measured the distance in 'inter-vertebral' units. RESULTS During the two year period, 13 of 24 intercostal catheters (54%) crossed the midline (i.e. were inserted too far). The mean (+/- SD) tip to midline distance was -1.29 (+/- 13.9) mm with a range varying between -40 to 34 mm with a calculated 'inter-vertebral' units mean (+/- SD) tip to midline distance of -0.32 (+/- 1.9) range -4.6 to 4.0. CONCLUSIONS Fifty four percent of the intercostal catheters inserted in our unit were inserted too far. As the distance markings on the Argyle intercostal catheters are marked from the last side-hole rather than from the tip of the catheter, Argyle intercostal catheters may be inadvertently inserted two centimetres further than they should be.