Chest Drains

Question 1

What does thoracic drainage aid(3)

Answer 1

•Aids diagnosis, stabilisation & treatment of conditions due to accumulation of fluid or air

Question 2

What can Needle Thoracocentesis be used for? (3)

Answer 2

• Confirm presence of air or fluid
• Obtain samples for lab evaluation
• ONLY for single, low volume procedures

Question 3

What equipment is needle for Thoracocentesis? (4)

Answer 3

• I/V catheter or needle (~21ga 1”)
• Sterile 10-20 ml syringe
• Extension tubing & three way tap
• Lab sample pots

Question 4

What evaluation can the lab do for pleural fluid? (9)

Answer 4

• Direct smears for cytology
• Aerobic & anaerobic culture & sensitivity
• SG, protein, clotting characteristics,
• presence of chylomicrons, TG’s
• Total cell counts

Question 5

What are the indications for a chest drain? (3)

Answer 5

• Management of dyspnoea due to pleural fluid or air
• Following thoracotomy
• Delivery of treatment (lavage, antibiotics etc)

Question 6

What is the guidline for a size of a chest drain?

Answer 6

•~ diameter of mainstem bronchus

Question 7

What chest drain size can we use for a cat?

Answer 7

•8 -16 FG

Question 8

What chest drain size can we use for a dog?

Answer 8

12-26 FG

Question 9

Where do you place a drain for a pneumothorax?

Answer 9

High

Question 10

Where do you place a chest drain for an effusion?

Answer 10

Place lower

Question 11

Where is the skin incision for a chest drain tube?

Answer 11

In dorsal third of lateral thoracic wall between ribs 10 -12

Question 12

Where do you tunnel with a chest drain tube? And what is the purpose of this “tunnel”?

Answer 12

• SC tunnel cranially to 7th -8th intercostal space
• “Tunnel” helps to maintain sterility and keep chest “air tight”

Question 13

How can you use local anaesthetic for a tube placement? What can you use?

Answer 13

•Intercostal nerve block , 2 - 3 spaces cranially

–Lignocaine

–Bupivacaine

Question 14

How is the tube then inserted after you have entered the chest?

Answer 14

• Drain is advanced a further 2 cm into chest
• Withdraw trocar
• Advance drain into pleural cavity

Question 15

Once the chest drain is in the chest what do you do next?

Answer 15

The pleural fluid is removed and a bung is placed on the end of the chest drain and then a drain clamp.

Then the chest drain is held in position with a finger trap suture.

Question 16

What happens what the drainage is finished?

Answer 16

Once drainage is finished an airtight seal is made and the gate clamp tightened. The bung is replaced and the chest drain is bandaged in place. All animals with a chest drain should have a/b cover and opioid analgesia

Question 17

What suture is used for a chest drain?

Answer 17

Finegr trap

Question 18

How often should you drain the chest?

Answer 18

• Depends!
• Continuous suction drainage

–When accumulation rate life threatening

–Fluid can be measured, air cannot

–Keeps pleural surfaces in contact

–Requires careful monitoring

Question 19

What is a heimlich valve used for? How does it work?

Answer 19

• For short term management of pneumothorax
• One way valve
• Air moves from thorax as animal breathes out
• Valve closes when animal breathes in
• Larger dogs >8kg
• Requires constant monitoring

Question 20

When do you remove the chest drain? (2)

Answer 20

•After several days drain itself will induce a serosanguinous effusion of approx.
2-3 ml/kg/day

–Gives a guideline for when to remove drain - if only see this much – remove drain!

•If problem has resolved (radiographical evidence)