Chest Drain Regular Flushing in Complicated Parapneumonic Effusions and Empyemas

There are no randomized controlled trials (RCTs) evaluating the role of regular chest tube flushing in the setting of pleural space infection for optimal drainage and treatment outcomes. Most studies of <16 Fr catheters have used both flushing and suction to decrease the likelihood of catheter blockage and improve drainage efficiency, however, this practice has never been studied prospectively or in RCTs. Regular flushing (e.g., 20-30 ml saline every 6 h via a three-way tap) is recommended for small chest drains by the British Thoracic Society (BTS) 2010 Guidelines. This practice is followed variably by some and not used by others. Importantly, the role of this practice in successful drainage of infected fluid, and patient-centric outcomes has not been investigated. Inconsistent flushing practices confound the interpretation of therapeutic modalities (such as intrapleural tissue plasminogen activator and deoxyribonuclease therapy) success or lack thereof and limit the execution of RCTs and prospective studies of the pleural space in the setting of infection.

Inclusion criteria

• Patients with complicated parapneumonic pleural effusion and empyema requiring chest tube placement as standard of care for inpatient management of their pleural space infection with or without intrapleural tissue plasminogen activator and deoxyribonuclease therapy
• Age > 18 years old.

Exclusion criteria

• Patients who have surgical tubes that can't accommodate a three-way stopcock.
• Study subject has any disease or condition that interferes with the safe completion of the study.
• Inability to provide informed consent.
• Inability to undergo a chest X-ray.
• If the managing clinician believes the chest tube will be placed for less than 24 hours.
• Patients with an indwelling pleural catheter (IPC)