Thoracic Drainage Flashcards
What are the 2 forms of thoracic drainage?
-Thoracocentesis
-Following placement of thoracostomy tube
Which drainage method can be used under local anesthetic?
Small-bore wire-guided catheters
Which drainage method can only be used under general anesthetic?
Trochar drains
Are troachar drains or wire guided catheters associated with fewer insertional infections and are more comfortable?
Small gauge wire guided catheters
What % of thoracostomy tubes have complications?
22%
What is mandatory to ensure correct chest tube placement?
Radiographs
What preventative methods should be used for all thoracostomy tube patients? (3)
- Never leave alone
- B/C
- Body stocking
What are the indications for immediate thoracocentesis? (2)
Dyspnoea
Dull/absent lung sounds
What should we do with fluid collected? (Tubes (2) and analysis (4))
EDTA and plain tubes:
Cytology
Biochemistry
Bacteriological analysis
Record volumes
Which position should a patient be in for thoracocentesis?
Sternal or lateral
or the position tolerate by patient!
Following aseptic preparation, which intercostal space is a needle passed in for thoracocentesis?
4-7th intercostal space
What is different about thoracocentesis where :
A. Air is suspected?
B. Fluid is suspected?
A. Least dependent part
B. Settle in most dependant part
What are the potential complications folowing thoracocentesis? (4)
- iatrogenic intrathoracic or abdominal damage
laceration of the - intercostal vessels
- pyothorax
- insufficient pleural drainage
How do we reduce the risk of lung lobe laceration in thoracocentesis?
flexible tubing is included between the syringe and needle and the bevelled edge of the needle is positioned parallel to the intrathoracic wall: this can be achieved by facing the bevelled edge towards the lung and angling the needle at 45°
How to avoid damage to intercostal vessels?
(located on the caudal edge of the ribs), the needle should be positioned midway between the ribs.
When should consideration be given to the preferential placement of a thoracostomy tube instead of thoracocentesis? (3)
- Patient over 32kg
- Animal is agitated
- High likelihood of repeated thoracocentesis being required
What anaesthesia is needed for placement of large bore trochar drain?
Local AND general anaesthesia
Why may small gauge wire guided catheters be more appropriate?
In an emergency as only local anaesthetic required.
How should a lidocaine block be placed?
into the appropriate intercostal space, just behind the rib and dorsal to the proposed site of tube/catheter placement. The two intercostal spaces caudally and cranially are infused likewise.
How should local anaesthesia be used as part of multi modal analgesia in thoracotomy tube patients?
Local anaesthetic (bupivacaine) should be regularly instilled into the chest cavity via the thoracostomy tubes
Why do we measure a trochar tube prior to placement?
To avoid entering cranial portion of thorax/mediastinum
Trochar tube:
Where is the skin incision?
Which intercostal space is it tunneled to?
a. 10th rib
b. Tunneled S/C, cranioventrally to 7-8th intercostal space
After tunnelling, how does the trochar enter the thorax?
The trochar tube is angled perpendicular to the body wall and held in one fist, with the distance between the fist and skin being approximately the thickness of the thoracic wall. Firm pressure is applied to the stylet until the tube penetrates the thoracic cavity; the purpose of the fist is to act as a buffer, preventing excessive advancement of the stylet into the thoracic cavity.
Prior to advacnign the trochar tube off the stylet, where is the tube redirected?
Towards contralateral shoulder
