RCA identified multiple contributing factors, including unrecognized and novel radiographic clues, human errors, communication breakdown, device design, and opportunities for improved systematic procedural approach. Using a structured root cause analysis (RCA), we examined two cases of retained pigtail catheter obturators resulting in catheter malfunction and unresolved pneumothorax. Results: We identified common complications of pigtail catheters from the medical literature, as well as 28 reports to FDA of. Traditionally large-bore tube thoracostomy has been the standard of care for treating many acute intrathoracic pathologies. It is recommended that we discontinue stocking larger sized chest tubes (32Fr, 36Fr) and Cook 9Fr pneumothorax set with metal trochar/needle. It's a core skill you must master early in your residency. Correct technique minimizes complications, and proper post-insertion management ensures clinical success. This guide breaks. However, in recent years, guidelines and statements from American College of Chest Physicians (ACCP) and British Thoracic Society (BTS) stress the value of observation, repeat imaging and prompt follow-up for stable, asymptomatic patients with no underlying lung disease or trauma.