It does, however, have merit, especially in an ambulatory population in the age of managed care and capitation. A pigtail catheter is inserted into the pleural space and the pneumothorax is aspirated. A stopcock is placed on the pigtail and the patient observed for 4 hours. If there is no reaccumulation, the catheter is removed and the patient discharged. If, however, there is reaccumulation of the pneumothorax after 4 hours, then there is presumably a large parenchymal leak and the catheter should be placed on suction through a PleurEvac.
Aspiration is usually more successful in primary than secondary pneumothorax.
The length of hospitalization in one series was 4 days. A randomized study was performed to look at the weaning mode of suction of the chest tube and was found to be more rapidly performed when left on constant suction up until the time of removal without prolonged periods of water seal. Again, this modality was shown to be more effective in primary than in secondary pneumothoraces. One could argue that if after 4 days of continuous suction on a chest tube there is a persistent air leak, then a more aggressive modality should be employed. Sometimes, a Heimlich valve can be attached to a chest tube that demonstrates a persistent air leak.