Bonnano’s catheter: A less invasive and cost-effective alternative for drainage of pleural effusion

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CTSNet classification: 14

To the Editor:

We read with interest the article by Chetty and colleagues.¹ Bonnano’s catheter has been proposed as a less invasive and cost-effective alternative for drainage of a pleural effusion. We congratulate them for their cost-effective and innovative approach of using a suprapubic catheter to drain the pleura.

Pigtail catheters using the modified Seldinger technique have been found to be well tolerated by the patient and are highly effective in drainage of pleural serous and chylous effusions but less efficacious in drainage of hemothorax or pneumothorax and empyema with acceptable risk of complications.²

We agree that akin to small catheters using the Seldinger technique,³, ⁴ Bonnano’s catheter can be used. However, with the length of the trocar and the mounted catheter being approximately 30 cm, one can lose track of the distance traveled in the thoracic cavity because there are no obvious markings on the catheter itself, and one can injure vital organs in the chest cavity, as in our institution’s experience (unpublished report), in which a misplaced Bonnano’s catheter pierced the left ventricle, and the tip of the catheter was found in the aortic root.

Before introduction of Bonnano’s catheter into general medical and surgical use to drain the pleura, this technique needs to be validated, and the results of a prospective trial are awaited. We suggest that modifications to the catheter should include surface markings, thereby allowing the distance traveled to be gauged, and reduction of the length of the trocar, thereby reducing the risk of untoward complications.

These catheters might be useful for drainage of simple pleural effusions after surgical intervention. Complications might be related to the misplacement of the trocar because of a lack of surface markings and unfamiliarity with chest anatomy. We therefore recommend this procedure to be performed by those with a detailed knowledge and appreciation of the thoracic cavity to avoid undue complications.

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References 

1. Chetty GK, Elahi MM, Siddagangaiah V, Leverment JN. Bonanno’s catheter: a less invasive and cost-effective alternative for drainage of pleural effusion. J Thorac Cardiovasc Surg. 2005;129:219–220
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2. Roberts JS, Bratton SL, Brogan TV. Efficacy and complications of percutaneous pigtail catheters for thoracostomy in pediatric patients. Chest. 1998;114:1116–1121
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3. Fuhrman BP, Landrum BG, Ferrara TB, Steinhorn DM, Connell AP, Smith-Wright DL, et al. Pleural drainage using modified pigtail catheters. Crit Care Med. 1986;14:575–576
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4. Gammie JS, Banks MC, Fuhrman CR, Pham SM, Griffith BP, Keenan RJ, et al. The pigtail catheter for pleural drainage: a less invasive alternative to tube thoracostomy. JSLS. 1999;3:57–61
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