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Surgery of Abdomen and Thorax Cavitities > Thoracic Drainage > Flashcards

Thoracic Drainage Flashcards

1
Q

What are the 2 forms of thoracic drainage?

A

-Thoracocentesis
-Following placement of thoracostomy tube

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2
Q

Which drainage method can be used under local anesthetic?

A

Small-bore wire-guided catheters

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3
Q

Which drainage method can only be used under general anesthetic?

A

Trochar drains

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4
Q

Are troachar drains or wire guided catheters associated with fewer insertional infections and are more comfortable?

A

Small gauge wire guided catheters

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5
Q

What % of thoracostomy tubes have complications?

A

22%

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6
Q

What is mandatory to ensure correct chest tube placement?

A

Radiographs

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7
Q

What preventative methods should be used for all thoracostomy tube patients? (3)

A
  • Never leave alone
  • B/C
  • Body stocking
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8
Q

What are the indications for immediate thoracocentesis? (2)

A

Dyspnoea
Dull/absent lung sounds

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9
Q

What should we do with fluid collected? (Tubes (2) and analysis (4))

A

EDTA and plain tubes:
Cytology
Biochemistry
Bacteriological analysis
Record volumes

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10
Q

Which position should a patient be in for thoracocentesis?

A

Sternal or lateral
or the position tolerate by patient!

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11
Q

Following aseptic preparation, which intercostal space is a needle passed in for thoracocentesis?

A

4-7th intercostal space

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12
Q

What is different about thoracocentesis where :
A. Air is suspected?
B. Fluid is suspected?

A

A. Least dependent part
B. Settle in most dependant part

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13
Q

What are the potential complications folowing thoracocentesis? (4)

A
  • iatrogenic intrathoracic or abdominal damage
    laceration of the
  • intercostal vessels
  • pyothorax
  • insufficient pleural drainage
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14
Q

How do we reduce the risk of lung lobe laceration in thoracocentesis?

A

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°

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15
Q

How to avoid damage to intercostal vessels?

A

(located on the caudal edge of the ribs), the needle should be positioned midway between the ribs.

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16
Q

When should consideration be given to the preferential placement of a thoracostomy tube instead of thoracocentesis? (3)

A
  • Patient over 32kg
  • Animal is agitated
  • High likelihood of repeated thoracocentesis being required
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17
Q

What anaesthesia is needed for placement of large bore trochar drain?

A

Local AND general anaesthesia

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18
Q

Why may small gauge wire guided catheters be more appropriate?

A

In an emergency as only local anaesthetic required.

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19
Q

How should a lidocaine block be placed?

A

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.

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20
Q

How should local anaesthesia be used as part of multi modal analgesia in thoracotomy tube patients?

A

Local anaesthetic (bupivacaine) should be regularly instilled into the chest cavity via the thoracostomy tubes

21
Q

Why do we measure a trochar tube prior to placement?

A

To avoid entering cranial portion of thorax/mediastinum

22
Q

Trochar tube:
Where is the skin incision?
Which intercostal space is it tunneled to?

A

a. 10th rib
b. Tunneled S/C, cranioventrally to 7-8th intercostal space

23
Q

After tunnelling, how does the trochar enter the thorax?

A

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.

24
Q

Prior to advacnign the trochar tube off the stylet, where is the tube redirected?

A

Towards contralateral shoulder

25
Q

How are trochar tubes secured?

A

Trap suture

26
Q

What distance should be marked on trochar prior to placement?

A

10th intercostal space to elbow

27
Q

How to you avoid lung damage on entry to thorax with a trochar?

A

Use hand on tube during placement approx 2cm off wall with tube in fist

28
Q

Which way is the tube directed when in thorax?

A

Cranioventral

29
Q

What may reduce iatrogenic damage to lungs compared to trochar placement?

A

Mini thoractomoty approach

30
Q

What measure are needed to be taken for mini thoractomy approach?

A

GA and ventilation

31
Q

When is thoracic radiography mandatory following placement of thoracostomy tube(s)?

A

Following placement of every thoracostomy tube regardless of clinical presentation and tube type.

32
Q

What technique is used to place a small gauge wire guided catheter?

A

Seldinger

33
Q

Where is the skin incision for small gauge wire guided catheter?

A

9th intercostal space

34
Q

Where is the introducer catheter inserted into the thorax with Seldinger approach?

A

Between ribs (9th). No tunneling as a small bore

35
Q

Seldinger approach:
What are the steps after advancing introducer in the thorax over the stylet and its removed? (Include measurements)

A

The J-wire is threaded through the catheter and advanced approximately 12-20 cm, or until resistance is felt.

36
Q

Seldinger technique:
What is left after the introducer is removed?

A

Guidewire left in place

37
Q

How is the small bore catheter advanced in the Seldinger technique?

A

The small-bore catheter is then advanced over the guidewire into the thoracic cavity and the guidewire removed.

38
Q

Seldinger technique - what is attached to the end of the catheter?

A

Needle free valve

39
Q

How is the catheter secured in seldinger technique?

A

Eyelets on the flange

40
Q

What should be used before draining tubes/fluid instillation?

A

Cleanse ports with alcohol wipes

41
Q

What nursing requirements are essential in patients with thoracostomy tubes? (4)

A

Patient must never be left unattended

Patient must wear an Elizabethan collar

Patient must wear a body stocking or T-shirt

Patient must be provided with generous multimodal analgesia

42
Q

When is a tube removed following air draining?

A

When zero is produced

43
Q

When is a tube removed following fluid draining?

A

2ml/kg/day or less

44
Q

How are tubes removed?

A

Sutures are removed, and the drain gently and steadily extracted. I cover the skin site with a film dressing if a trochar drain has been removed. No sutures are required.

45
Q

Which thoracostomy tube is associated with greater pain?

A

Trochar

46
Q

What percentage of thoracostomy tubes are associated with complications?

A

22%

47
Q

Name thoracostomy tube complications? (9)

A
  • Haemothorax
  • Problems of tube maintenance
  • Insufficient pleural draining
  • Iatrogenic thoracic/abdo drainage
  • Pneumothorax
  • Pleural effusion
  • Improper tube placement
  • Inability to place tube
  • Pyothorax
48
Q

What is reported as the most common complication of thoracotomy tube placement?

A

Failure of the catheter to drain as a result of kinking or malpositioning.

Surgery of Abdomen and Thorax Cavitities (10 decks)

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