Laronga et al developed an algorithm for management of a pneumothorax occurring after insertion of a central venous catheter. The authors are from the University of Texas M.D. Anderson Cancer Center in Houston.



(1) size of pneumothorax

(2) clinical symptoms

(3) difficulty with catheter insertion

(4) previous central venous catheter placement


Therapeutic options:

(1) observe

(2) insert small pigtail catheter

(3) insert large chest tube


A large chest tube is inserted if:

(1) the patient is critical (emergency associated with pneumothorax)

(2) a trial of a small pigtail catheter fails


A small pigtail catheter is inserted if:

(1) the size of the pneumothorax is > 30%

(2) the patient is symptomatic but not critical

(3) the insertion of the catheter was difficult

(4) the patient has a history of a previous central venous catheter placement

(5) a trial of observation fails


If neither a large chest tube nor a small pigtail catheter is indicated, then the patient can be observed.


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