Thoracic surgery techniques

Question 1

Why do chest drains need to be placed?

Answer 1

Removal of fluid or air from the pleural cavity

Question 2

What are the indications for a chest drain?

Answer 2

Pneomothorax 
chylothorax 
Haemothorax 
Pyothorax 
following all thoracic surgeries 
malignant pleural effusion

Question 3

What equipment do you need to place a chest drain?

Answer 3

Suture material 
sterile gloves
clippers 
prep-solution 
chest drain (soft, non-irritant, radiopaque, +/- stylet, fenestrated)
scalpel blade) 
Local blocks

Question 4

What are the different types of chest drains?

Answer 4

Silicone
PVC or polyurethane
Fenestrations

Question 5

How do you select the size of a chest drain?

Answer 5

Fluid/air being drained
Larger the drain larger trauma greater risk of leaks
Air can be drained through small bore catheters

Question 6

How do you place a chest drain?

Answer 6

Lateral recumbency
clip and prep 4th-11th rib
local anaesthetic 7-8th rib
Incision over the 10th rib tunnelled under the skin and muscle until the 7th rib
chest tube with introductory bevelled needle
with or without trocar

Question 7

Chest drain care

Answer 7

Aseptic technique 
cover exits 
Check regularly  for blockages
Check regularly that it is still in place
clean stoma site and exit of the drain 
remove ASAP 
Check for breaks in air-tight seal
Prevent patient interference
record drainage output 
check system for any damage, kinks, broken connections

Question 8

How should you take fluid from a chest drain?

Answer 8

3 way tap (intermittent)
helmich valve (continuous)
collection bag and concertina (continuous)
3 bottle system,
closed chest drainage system(continuous)

Question 9

How should intermittent drainage for chest drains be carried out?

Answer 9

aseptic
every 2 -4 hours
monitor for dyspnoea

Question 10

What are the complications of chest drains?

Answer 10

Infection 
wound dehiscence 
air in the line 
broken system 
blockage
Internal trauma 
Arrythmia
leaks

Question 11

What are the common causes of pneumothorxa and how is it treated?

Answer 11

pulmonary blebs and bulla or trauma
Thoracocentesis
or chest drain placement
small bore catheter sufficient to drain air

Question 12

What tube should be placed after surgery to correct pyothorax?

Answer 12

Two drains on both sides

large drains to allow for thick fluid to be removed

Question 13

How should you prepare a patient for chest surgery?

Answer 13

Large clips
legs extended cranial
use of sandbags

Question 14

what specialised instruments are used during thoracic surgery?

Answer 14

rib spreaders 
Lahey forceps (right angled)
Pledgeted sutures 
Statinsky clamp
Mechanical staplers