Thoracocentesis: indications, preparation and conduct, consequences. Drainage of the pleural cavity (pleural drainage)

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Thoracocentesis (thoracentesis) is a puncture procedure chest wall to enter the pleural cavity. Thoracocentesis is performed for the purpose of diagnosis or for the purpose of treatment.

From the inside, our chest is lined with a parietal pleura, and the lungs are covered with a visceral sheet. The space between them is the pleural cavity. Normally, it always contains about 10 ml of liquid, which is constantly formed there and simultaneously absorbed. This fluid is needed for a good sliding of the pleural sheets during breathing.

The pleura is rich in blood vessels. In a number of diseases, the permeability of these vessels increases, and the production of fluid increases or its outflow is disturbed. As a result, a pleural effusion is formed: the volume of fluid increases dramatically, and it cannot be eliminated by any other means than evacuation through a puncture.

When is thoracocentesis performed?

Thoracocentesis is performed:

Contraindications for thoracocentesis

If we are talking about evacuation a large number liquid or air from chest cavity, absolute contraindications to pleural puncture does not exist, since speech in this case is a violation of vital important functions(any effusion or air compresses the lung and shifts the heart to the side, which can lead to acute insufficiency of these vital important organs).

Therefore, thoracocentesis in such cases cannot be performed, unless the patient himself or his relatives refused the procedure in writing.

Relative contraindications to thoracocentesis:

1. Reduced blood clotting (INR greater than 2 or platelet count less than 50 thousand).
2. portal hypertension and varicose veins pleural veins.
3. Patients with one lung.
4. Severe severe condition of the patient, hypotension.
5. Fuzzy localization of the effusion.
6. Difficult to stop cough.
7. Anatomical defects chest.

Examinations before the thoracentesis procedure

If fluid or air is suspected in the pleural cavity, the patient is usually referred to radiography. This diagnostic method is quite informative in this case and often it is enough to clarify the presence of effusion and its quantity, as well as to diagnose pneumothorax (presence of air in the chest cavity).

For the same purpose, one can ultrasonography pleural cavity(ultrasonography). Ideally, thoracocentesis should be performed under direct ultrasound guidance.

Sometimes in doubtful cases appointed CT scan chest(mainly to clarify the localization of encysted pleurisy).

Preparation for the thoracocentesis procedure

Thoracocentesis can be performed on an inpatient or outpatient basis. Outpatient thoracocentesis can be performed as diagnostic procedure, and also as a method symptomatic treatment in patients with a clear diagnosis ( oncological diseases, effusions in heart failure, liver cirrhosis).

position of the patient during thoracocentesis

Consent to the procedure must be signed. If the patient is unconscious, the consent is signed by close relatives.

Before the procedure, the doctor once again determines the level of fluid by percussion or (ideally) ultrasound.

It is preferable that the procedure be performed by a thoracic surgeon using a special thoracocentesis kit. But in emergency cases Thoracocentesis can be performed by any doctor with a suitable thick needle.

Thoracocentesis is performed under local anesthesia. The position of the patient is sitting on a chair, with the body tilted forward, hands folded on the table in front of him or brought behind his head.

Particularly anxious patients can be premedicated with a tranquilizer before the procedure.

If the patient is in serious condition, the position may be horizontal. serious condition The patient also requires standard monitoring (BP, ECG, pulse oximetry), access to the central vein, and oxygenation through a nasal catheter.

How is thoracocentesis performed?

The puncture is carried out in the 6-7th intercostal space in the middle between the mid-axillary and posterior axillary lines. The needle is inserted strictly along the upper border of the rib to avoid damage to the neurovascular bundle.

The skin is treated with an antiseptic.

Perform tissue infiltration with a solution of novocaine or lidocaine, gradually moving the syringe with a needle from the skin deep into all layers. The piston in the syringe is periodically retracted in order to notice in time if the needle enters the vessel.

The periosteum of the rib and the parietal pleura should be especially well anesthetized. When the needle enters the pleural cavity, a failure is usually felt, and when the piston is pulled up, pleural fluid begins to flow into the syringe. At this point, the depth of penetration of the needle is measured. The anesthesia needle is removed.

A thick thoracocentesis needle is inserted at the site of anesthesia. It is passed through the skin subcutaneous tissue approximately to the depth that was noted during anesthesia.

An adapter is attached to the needle, which is connected to the syringe and to the tube attached to the suction. The pleural fluid is drawn into a syringe for referral to the laboratory. The liquid is distributed into three test tubes: for bacteriological, biochemical research, as well as for the study of cellular composition.

To remove large volumes of fluid, a soft, flexible catheter is inserted through a trocar. Sometimes a catheter is left to drain the pleural cavity.

Usually, no more than 1.5 liters of liquid are sucked off at a time. With the appearance of severe pain, shortness of breath, severe weakness, the procedure is stopped.

After the puncture is completed, the needle or catheter is removed, the puncture site is again treated with an antiseptic and an adhesive bandage is applied.

Video: Bulau pleural cavity drainage technique

Video: an example of a thoracocentesis

Video: English educational film on pleural puncture

Thoracocentesis for pneumothorax

Pneumothorax is the entry of air into the chest cavity due to trauma or spontaneously due to rupture of the lung against the background of its disease. Thoracocentesis with pneumothorax is performed in the case of tension pneumothorax or with normal pneumothorax with an increase in respiratory failure.

The puncture of the chest wall with pneumothorax is carried out along the midclavicular line along the upper edge of the third rib. Air is aspirated with a needle or (preferably) a catheter.

The air from the pleural cavity comes out with a characteristic whistling sound. Aspirate as much air as needed to eliminate the symptoms of hypoxia.

Often, pneumothorax requires drainage of the pleural cavity - that is, a catheter or drainage tube it is left for some time, the end of the catheter is lowered into a vessel with water (like a "water lock"). Removal of the drainage tube is carried out one day after the cessation of air discharge, after X-ray control expansion of the lung.

Sometimes, with chest injuries, hemopneumothorax occurs: both blood and air accumulate in the pleural cavity. In such cases, a puncture can be performed in two places: for fluid evacuation - along the posterior axillary line, for air removal - in front along the midclavicular line.

Video: thoracocentesis for decompression with tension pneumothorax

After puncture

Immediately after the puncture, a dry cough, pain in the chest (if the pleura was inflamed) may appear.

Possible complications after thoracocentesis

In some cases, thoracocentesis is fraught with the following complications:

• Lung puncture.
• The development of pneumothorax due to leakage of air through a puncture or from a damaged lung.
• Hemorrhage into the pleural cavity due to vascular damage.
• Pulmonary edema due to simultaneous evacuation of a large amount of fluid.
• Infection with the development of the inflammatory process.
• Damage to the liver or spleen from too low or too deep a puncture.
• subcutaneous emphysema.
• Fainting due to sharp decline pressure.
• Extremely rare - air embolism with a fatal outcome.

Thoracocentesis - medical reception for evacuation of fluid or gas accumulated in it from the pleural cavity by puncture of the pleural cavity and installation of drainage. Indications:

1. A large accumulation of fluid (borders of dullness in front of the third rib or higher), putting pressure on the organs of the chest and abdominal cavity, causes life-threatening phenomena: suffocation, cyanosis, swelling of the neck and head; without causing such phenomena, it is still life-threatening, since under conditions that change intrathoracic pressure, it can lead to sudden death.

2. The liquid, despite the use of appropriate methods of treatment, does not resolve for a long time, which causes wrinkling of the lung due to its compression.

Z. Re-accumulation of fluid in the pleura after a single or even multiple removal of it, or the cause is unremovable, for example, when malignant neoplasms. Relative contraindications: 1) large transudates. 2) copious hemorrhagic exudates, in which fluid extraction is usually avoided 3) serous-purulent effusions in acute streptococcal pleurisy, which are subject to complete removal by immediate resection, but can be cured by prolonged suction or suction with irrigation. Contraindications: 1) active pulmonary tuberculosis, since straightening it can cause an exacerbation of the process. 2) serous-purulent tuberculous effusion.

Methods for extracting fluid from the pleural cavity: by gravity, extraction by suction, siphon extraction. Instruments: puncture needle, Poten's trocar, mandrin to Poten's trocar, rubber tube (drainage), receiving vessel, test puncture instruments.

Active drainage is a fundamental intervention in the chest cavity. If this intervention is carried out carefully, then the possibility postoperative complications is reduced to a minimum. With improper use of drainage, recovery will not occur, septic complications may develop. The drainage-suction apparatus consists of a drainage tube, which is inserted into the pleural cavity, and an aspirating system connected to the drainage. The number of used aspirating systems is very large. Various rubber and synthetic tubes are used for suction drainage of the pleural cavity. For the most commonly used drainage, a rubber tube about 40 cm long is used with several side holes at the end. This tube is placed along the lung (from base to apex) and passed over the diaphragm from the pleural cavity to the outside. The drainage is fixed to the skin with a knotted U-shaped suture. When the aspirating drainage is removed, the threads are tied again, and thus the opening in the chest is hermetically closed.

Introduction of suction drainage. In the chest between the two pleural sheets, the intrapleural pressure is below atmospheric pressure. If between the pleural sheets air gets in or liquid, then normal physiological state can only be restored by prolonged suction drainage. A closed chamber is used to remove pleural fluid in recurrent pneumothorax and to treat empyema. drainage system. This drain is usually introduced into the intercostal space through a trocar. The thickness of the drainage tube is determined in accordance with the consistency of the suctioned substance (air, as well as watery liquid or serous, fibrinous, bloody, purulent liquid). On the drainage, paint or thread mark the place to which it will be introduced. The size of the trocar should correspond to the size of the drainage. It is advisable to have three trocars of different sizes with suitable tubes of 5.8 and 12 mm in diameter. Before inserting the trocar, make sure that the selected drainage tube passes easily through it.

aspiration systems. There are so-called individual ("Bed side") and centralized systems. The suction action due to the hydrostatic effect can be obtained by a tube submerged under water, a water or gas pumping device (in this case the action is based on a valve effect) or an electric pump.

Both in an individual and a centralized system, individual regulation must be ensured. If the exit of air from the lung is insignificant, then due to its simplicity, the Bulau drainage system is still successfully used today, which can be sufficient to expand the lung. A glass tube immersed under water (disinfectant solution) is provided with a valve made from a finger cut off from a rubber glove, which prevents back suction. In the Bulau system, when moving the receiving containers, the physical law of communicating vessels is used to create a suction effect. The Fricar air pump best suits today's requirements. This device can work continuously without getting hot. The strength of the negative pressure effect can be precisely adjusted.

Sometimes, in order to diagnose the disease, the doctor needs to get the fluid that has accumulated in the pleural cavity. For this, thoracocentesis (thoracentesis) is used. In this article, we will explain what is this procedure and how it is carried out.

Thoracocentesis is invasive manipulation during which a needle or trocar is pierced through the chest wall to remove fluid or pus that has accumulated in the pleura.

A similar procedure is carried out in the operating room or in the patient's room. If required, the fluid obtained during the manipulation is sent to the laboratory for examination.

Thoracocentesis is used for therapeutic purposes - to remove liquid, and as a diagnostic to find out the factors that provoked the accumulation of fluid in the chest cavity.

Indications for carrying out

This procedure is carried out in such cases:

Limitations for thoracocentase

When it is necessary to evacuate a large volume of fluid or air from a cavity in the sternum, then there are no unconditional contraindications to thoracentesis. Indeed, in this situation, it is understood that the work of vital organs has been disrupted (the accumulation of fluid or air compresses the lungs and moves the heart to the side, this sometimes causes the formation of acute insufficiency in these bodies).

For this reason, the procedure is not carried out in this case, only when the patient himself or one of his relatives signed a refusal from thoracocentesis.

Comparative limitations to thoracocentesis are as follows:

1. Reduced blood clotting (INR more than 2 or platelets less than 50 thousand).
2. At portal hypertension and varicose veins in the pleural veins.
3. If the patient has one lung.
4. With severe severity of the human condition, hypotension.
5. When it is inaccurately determined where the effusion is localized.
6. With difficult to stop cough.
7. With anatomical defects of the sternum.

How to prepare

Pleurocentesis is performed in a hospital or outpatient setting. Outpatient thoracocentesis is used for diagnostic purposes, as well as symptomatic therapy in patients with established diagnosis(in the presence of oncological pathology, effusions in heart failure, liver cirrhosis).

IN without fail the patient must sign a consent to the invasive intervention. When the patient is unconscious, the consent is signed by the next of kin.

Important. Before starting thoracocentesis, the doctor re-determines the volume of the effusion by using percussion or ultrasound diagnostics.

As a rule, such an operation is performed by a thoracic surgeon with special instruments for thoracentesis. However, in emergency it is possible to perform thoracentesis by any doctor using an appropriate thick needle.

The procedure is carried out under local anesthesia. During thoracocentesis, the patient sits on a chair, tilting his torso forward, folds his hands on a table that stands in front of him or turns his head.

If the patient is in anxiety, then a tranquilizer may be administered to him.

For severely ill patients, pleurocentesis is performed horizontally. In this case, the patient is also subjected to standard monitoring (pressure, ECG, pulse), access to central vein and oxygenation with a nasal catheter.

Technique for performing thoracocentesis

A puncture is made in the region of 6-7 intercostal space between the middle axillary and posterior axillary lines. The needle is inserted exactly along the upper border of the rib to prevent disturbances in the bundle of nerve vessels.

Important. The skin is treated with an antiseptic.

The integument is impregnated with novocaine or lidocaine by methodically advancing the syringe with a needle from skin inside through all the covers. The piston in the syringe is retracted from time to time, this is necessary for timely detection that the needle has entered the vessel.

Carefully anesthetize the costal periosteum and parietal membrane. When the needle enters the chest cavity, it can be felt that it has failed, and during the piston tightening, serous contents are noticed entering the syringe. At this point, measure how deep the needle has penetrated. The anesthesia needle is removed.

A thick needle for thoracentesis is inserted into the place where anesthesia was performed. It is carried out through the skin and subcutaneous membranes approximately at the distance that was noted during anesthesia.

An adapter is connected to the needle, combined with a syringe and a tube attached to the suction. serous fluid is drawn into a syringe to be sent to a laboratory later. The liquid is distributed in three test tubes: for bacteriological and biochemical examination, as well as for determining the cellular structure.

The adapter then switches to suction to evacuate the effusion.

To remove a large amount of effusion, a soft flexible catheter is used, which is inserted using a trocar. In some cases, a catheter may be left in place to drain pleural fluid.

As a rule, no more than one and a half liters of effusion is sucked out instantly. If appears strong pain, shortness of breath or severe weakness, the procedure is terminated.

At the end of the procedure, the needle or catheter is removed, and the area where the puncture was made is treated again. antiseptic and apply an adhesive bandage.

After thoracentesis, some complications may occur. Sometimes infection can begin if the pus is not completely removed or it has accumulated again.

It should be noted that there is a possibility of complications with any, especially invasive, intervention, but the need for such a procedure is greater than the risk of possible undesirable consequences.

Conclusion

If there is a need to evacuate fluid from the pleural cavity in diagnostic or medicinal purposes then a thoracocentesis is performed. Although absolute contraindications and are absent, however, there are some restrictions on such an invasive intervention, so it is necessary to consult a doctor.

(pleurocentesis) - a procedure in which the pleura is punctured through the intercostal space in order to divert and aspirate pathological contents (or), normalize respiratory function, and for content diagnostics.

Transudate effusions result from reduced plasma and result from decreased plasma oncotic pressure and increased hydrostatic pressure. The most common causes are metastasis in the chest cavity, pathologies of the kidneys and liver.

Exudates of exudate are formed under the influence of local pathological or surgical processes, causing an increase capillary patency and subsequent exudate of intravascular components. There are many reasons for this: pulmonary embolism, dry pleurisy, etc.

The nature and volume of pleural effusions and the amount of air is determined by the doctor by x-ray of the chest cavity and directly during thoracocentesis in a dog or cat.

Indications

The main indications for thoracocentesis are the presence of air, large pleural effusions, or pleural effusions of any size in the pleural space that cause difficulty in breathing.

Contraindications and complications

A contraindication to thoracocentesis in animals is increased bleeding, but if there is a sufficiently large amount of blood in the pleural space, respiratory failure. Then the doctor weighs the risks and decides whether this procedure is needed now. If the case is not an emergency, then there is time to correct blood clotting.

Owners should be warned about possible complications procedures - lung injury.

Technique

The technique for performing thoracocentesis in dogs and cats is as follows. The procedure is carried out most often without sedation and local, it is not painful and is well tolerated by animals. At the same time, oxygen is supplied. However, with aggressive or very restless patients, it is sometimes necessary to resort to sedatives.

For thoracocentesis, sterile needles of 18–22 diameters, 20 ml syringes, an infusion system, a three-way stopcock or hemostatic clamp, and a vessel for collecting fluid are required.

Thoracocentesis is usually performed in the 7th or 8th intercostal space. right side(this is the safest area for inserting needles) or in areas of maximum fluid accumulation. The position of the animal depends on the type of pathology. So, in the presence of air in the chest cavity, the animal is laid on its side and the puncture is done dorsally, and in the presence of fluid - in a standing position, sitting or on the chest, and the puncture is ventral. The injection site is carefully cut off and treated with an antiseptic solution.

The puncture is carried out along the cranial edge of the rib, since there are intercostal vessels and nerves on the caudal edge.

The needle is inserted into the pleural space with a cut to the lungs and parallel to the chest wall to avoid injury. lung tissue. Aspiration of the contents is carried out while it is possible to remove fluid through the system, it is carried out with a slight negative pressure to prevent lung tissue from being sucked into the needle. It is usually not possible to completely remove content.

Thoracocentesis is performed 1-3 times, if the fluid is collected again, it is recommended to apply

Thoracostomy (in other words, fenestration of the chest wall) is performed to fast withdrawal intoxication by simultaneous emptying of the abscess formed during pyopneumothorax, and creating access for its sanitation through a wide thoracotomy wound. Thoracocentesis- puncture of the chest wall in order to establish a diagnosis, to obtain the contents of the chest cavity, as well as to remove accumulated exudate or transudate for the purpose of treatment.

• Thoracocentesis
• Thoracostomy
  • Execution Method
• Removal of pleural drainage

Thoracocentesis

Indications:

• Establishment of etiology pleural effusion;
• Removal of pleural effusion for therapeutic purposes;
• For the administration of drugs;
• Emergency removal of air in tension pneumothorax.

Contraindications:

• Obliteration of the pleural cavity;
• Coagulopathy - INR more than 2, thrombocytopenia less than 50×109/l;
• Varicose pleural veins in portal hypertension.

Thoracocentesis technique

A chest x-ray should be taken prior to the procedure. In case of pneumothorax, to remove air from the pleural cavity, the puncture should be carried out in the 2nd intercostal space along the midclavicular line (with the patient sitting) or in the 5th-6th intercostal space along the midaxillary line (with the patient lying on a healthy side with a hand abducted behind the head).

Attention. For pneumothorax, perform pleural puncture only in the most urgent cases (for example, tension pneumothorax). In the vast majority of cases, pneumothorax requires pleural catheterization.

With hydro- and hemothorax, puncture can be performed in the 6-7th intercostal space along the posterior axillary or scapular line (landmark - the lower edge of the scapula). A puncture is done to the patient in a sitting position - a person sits on the edge of the bed, putting his hands behind his head or putting them on the bedside table. The nurse insures him by holding his shoulders. If the patient cannot be seated, then the puncture site is chosen closer to the midaxillary line in the 5th-6th intercostal space.

1. Treat the puncture site with an antiseptic solution;

2. Draw 10 ml of 1% lidocaine solution into the syringe. At the point chosen for puncture with an intramuscular needle (G22), perform layer-by-layer anesthesia of the skin, subcutaneous tissue, muscles, periosteum of the rib and parietal pleura. Gently advance the needle just above the upper edge of the underlying rib into the pleural cavity, with the syringe in the plunger-to-pull position. After the appearance of pleural contents in the syringe, remove the needle;

3. Take a needle from the pleural puncture kit or another of suitable gauge (G14-18) and length (8-10 cm) and connect it to a 10 ml syringe;

4. At the selected point, maintaining the vacuum in the syringe (the “piston towards you” position), slowly and smoothly pierce the chest wall and parietal pleura. The puncture of the chest wall is done, focusing on the upper edge of the underlying rib in order to avoid injury to the intercostal vessels;

5. If air or pleural contents begin to enter the syringe, the advance of the needle is immediately stopped;

6. Collect pleural contents into the syringe for laboratory research. With hemothorax, a Revelua-Gregoire test is performed - if the blood obtained from the pleural cavity forms clots, this indicates continued bleeding from the pleural cavity;

7. Depending on the situation, a conductor is passed through the needle and the pleural cavity is catheterized according to Seldinger ( preferred option). Or attach a disposable blood transfusion system to the needle. Connect the distal end of the system to the suction low pressure(vacuum 20-30 cm water column), or, if the contents of the pleural cavity is fluid, simply lower its end below the level of the puncture.

Use a special catheter for pleural catheterizations. If the catheter you need is not available and you are using a central vein catheter to catheterize the pleural cavity. Choose for these purposes a catheter of the maximum diameter available to you. Make a small (1/3 of the catheter diameter) lateral hole 3-4 cm from the distal end with a scalpel blade - this will dramatically increase the efficiency of its work. Do not use peripheral venous catheters for drainage of the pleural cavity - they are too thin-walled and easily bent.

8. The signal to remove the needle (or catheter) is the appearance of pain as a result of its contact with visceral pleura, cessation of the release of fluid, air;

9. If the fluid is poorly evacuated, by changing the position of the patient's body, achieve an increase in the outflow rate. Or connect a low-pressure suction to the catheter for several hours via an extension cord. It is clear that when a needle was used instead of a catheter in a patient, such manipulations cannot be carried out;

10. After the end of the procedure, the skin puncture site is treated with an antiseptic solution and covered with a sterile gauze sticker.

11. Take a follow-up chest x-ray.

Thoracostomy

Indications

• Hemothorax;
• Pleural effusion in significant amount, which could not be evacuated by pleural puncture;
• Purulent pleurisy.

Execution Method

Preparation

1. Specify the localization of pneumothorax or pleural effusion using chest x-ray;

2. The patient should be in a prone or reclining position, the arm on the side of the lesion is thrown behind the head. The triangle is highlighted in the figure, where the introduction of drainage is most safe (6-4 intercostal space along the anterior axillary or mid axillary line);

3. Provide venous access and oxygenation through a nasal catheter. Consider premedication (benzodiazepines, narcotic analgesics);

4. Set up standard monitoring: ECG, SpO2, non-invasive blood pressure;

5. Determine the fifth intercostal space along the midaxillary line (located at the level of the nipple in men and the base of the mammary gland in women). With a marker, or otherwise, mark this point;

6. Widely treat the puncture site with an antiseptic and limit the skin with sterile wipes;

7. Draw 20 ml of 1% lidocaine solution into the syringe. At the point chosen for puncture with an intramuscular needle, perform layer-by-layer anesthesia of the skin, subcutaneous tissue, muscles and parietal pleura, focusing on the upper edge of the underlying rib;

8. Use a scalpel to make a 1-1.5 cm incision in the intercostal space just above the upper edge of the underlying rib. Drainage is prepared in advance. The end of the drainage, intended for insertion into the pleural cavity, is cut obliquely. Stepping back 2-3 cm from it, 2-3 side holes are made. 8-12 cm above the upper lateral opening, which depends on the thickness of the chest and is determined by pleural puncture, a ligature is tightly tied around the drainage. The other end of the drain is clamped with a clamp.

9. Further introduction of the drainage tube into the pleural cavity can be carried out through a trocar or open way with a clamp. And if smaller diameter drainages are used - according to Seldinger.

A trocar with an inserted stylet is inserted into the pleural cavity through the incision with rotational movements, focusing on the appearance of a feeling of failure. Then the stylet is removed and a drainage tube is inserted through the trocar sleeve into the pleural cavity. After removing the sleeve, the tube is carefully pulled out of the pleural cavity until a control ligature appears.

Open method: through the incision of the skin and subcutaneous tissue, a drainage tube is inserted into the pleural cavity with rotational movements, clamped with the tip of a clamp with sharp branches. After feeling a sense of failure, the clamp is slightly opened, and the drain is pushed to the required depth with the other hand. Then the clamp is carefully removed, holding the tube at the required level.

A U-shaped suture is placed around the tube to seal the pleural cavity. The seam is tied with a bow on the balls. The tube is fixed to the skin with 1-2 sutures, paying attention to the tightness of the sutures around the tube. special sets and catheters for drainage of the pleural cavity.

Attention. Do not use disposable tubes as drains. intravenous systems. They are thin-walled, easily pinched.

10. In the case of a small pneumothorax, or in the presence of a liquid effusion, a 10-12 size French catheter (1Fr = 0.33 mm) is sufficient. With hemothorax - the size of the drainage tube should be at least 24 Fr (preferably 28-30 Fr). Thoracostomy using a trocar catheter, or a Seldinger catheter, is quite effective in pneumothorax, pleurisy, but not in the case of hemothorax. In case of hemothorax, immediately install a large diameter drainage tube (28-30 Fr).

11. Place a gauze bandage between the skin and the drainage tube and secure the drainage tube to the chest with adhesive tape.

12. Through an extension cord, connect the drain tube to a special (cavitary) low pressure suction. Vacuum - 20 cm of water. Art. (not higher - 30 cm water column).

Attention. Never connect the drain to a conventional surgical suction. This is deadly for the patient.

Another option is Bulau drainage. A safety valve is fixed at the outer end of the drainage tube - a finger from a rubber glove with a cut 1.5-2 cm long. Or an industrial valve. The valve must be immersed to a depth of 3-4 cm in a vial with a sterile solution (sodium chloride 0.9%). The tube is fixed so that the valve does not float and is always in solution. The valve prevents air and the contents of the jar from entering the drain tube. Do not pinch the pleural drainage, even for a short period until it is removed, if the patient is undergoing mechanical ventilation.

13. Once the drain is in place, take a follow-up chest x-ray.

Removal of pleural drainage

With pneumothorax, the drainage is removed if air has not been discharged through the tube during the day. In other cases, the question of the time of removal of the tube is decided individually. Usually, the drainage is removed when the volume of discharge from the pleural cavity becomes less than 100-200 ml / day.

Deletion sequence

1. Remove the bandage and adhesive tape, cut off the seam that secures the tube;

2. Apply pressure to the skin next to the tube and remove the drain while exhaling;

3. Tie a U-shaped seam, apply a gauze bandage;

4. Take a follow-up chest x-ray to rule out pneumothorax.