LECTURE 10 (Drainage of thorax) Flashcards
What is a Thorax drain?
A tube inserted through the chest wall between the ribs and into the pleural cavity to allow drainage of air (pneumothorax), blood (hemothorax), fluid (pleura effusion) or pus (empyema) out of the chest
What is the function of effective drainage?
It helps restore hemodynamic and respiratory stability by optimising ventilation/perfusion and minimising mediastinal shift
What are the commonly used positions?
- Patient lying at 45 degrees with their arm raised behind the head to expose the axillary area
- Forward lean position
- Patient lying on their side with the affected side uppermost
What anaesthetic should be used?
Up to 3mg/kg of Lidocaine
What size drains must be used?
Small calibre drains (12Ch) are better tolerated and associated with less discomfort in SPONTANEOUS PNEUMOTHORAX and SIMPLE EFFUSIONS -> but in TRAUMATIC PNEUMOTHORAX, HEMOTHORAX and EMPYEMA may need larger drains
What does the “safe triangle” consist of?
- Lateral border of Pectoralis major
- Anterior border of Latissimus dorsi
- Level of nipple
Where should the drain be placed?
- The 5th intercostal space in the mid-axillary line just above the rib
- In the presence of an apical pneumothorax -> 2nd intercostal space
What are the steps to Chest-tube insertion?
1) Small incision is made at midaxillary line between 4th and 5th ribs on a line lateral to nipple
2) Clamp dissects over rib to avoid nerves and vessels beneath rib
3) Clamp opens to spread muscles
4) Finger is used to explore space, avoiding need for sharp instruments
5) Clamp holds chest tube and guides it into place
Describe removal of the chest drain
When the tube is ready to be removed, the patient should be asked to perform a VALSALVA MANEUVER (to increase the pleural pressure and prevent air entering the pleural cavity) and the tube is withdrawn quickly -> Previously placed suture is then tied to close the hole
