Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ACVN - SURGICAL NURSING > Thoracic Surgical Treatments > Flashcards

Thoracic Surgical Treatments Flashcards

You may prefer our related Brainscape-certified flashcards:
Nursing Mental Health flashcards Nursing Management of Care flashcards NCLEX-PN® flashcards NCLEX-RN® flashcards Nursing Fundamentals flashcards Nursing Pediatrics flashcards Nursing Safety & Infection flashcards Nursing Pharmacology flashcards Nursing Maternity flashcards Family Nurse Practitioner (FNP) flashcards
1
Q

what is a thoracocentesis?

A

procedure involving the puncture of the pleural space for diagnostic and/or therapeutic purposes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what should you prioritise when performing a thoracocentesis?

A
  • safety
  • sterile skin prep
  • gloves
  • sterile drape
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what equipment do you need for a thoracentesis?

A
  • Oxygen
  • Short-acting local anaesthetic +/- anxiolytic
  • Sterile prep (clippers, scrub, surgical spirit, sterile gloves +/- drape)
  • Needle / IV catheter / butterfly catheter. Butterfly catheters available 20/22g for cats/small dogs &
    18/20g for larger dogs
  • IV catheters
  • Needles / Butterflies
  • Assistant
  • 3-way tap
  • 20ml syringe – size determined by volume expected
  • +/- Extension set
  • Kidney dish / jug
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is a chest drain?

A

A tube placed into the
pleural space to allow
ongoing, continuous or
intermittent therapeutic
drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When is a chest drain usually placed?

A

➢ Intermittent thoracocentesis not working
➢ Following thoracotomy
➢ Long term pleural drainage required
➢ Instillation of medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

why might an intermitten thoracentesis not work?

A
  • Too much air/fluid being produced
  • Fluid too thick to come through butterfly
  • Proving too risky – causing lung trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

why might you place a chest drain after thoracotomy?

A
  • Remove fluid/air introduced during surgery
  • Detect fluid/air being produced due to the underlying condition
  • Detect fluid/air being produced due to complications of surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what medication can be put through a chest drain?

A
  • Local anaesthetics
  • Saline for lavage of pyo
  • Antibiotics
  • Chemotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what types of chest drain are there?

A
  • Large bore
  • Narrow bore
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what techniques are there to place a chest drain?

A
  • Trocar
  • Seldinger technique
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how would you select a chest drain?

A
  • Type
  • Size - 6Fr - 20Fr
  • Placement method - closed or open chest
  • Site - unilateral or bilateral? fenestrations all in chest?
  • Connectors -
  • Securing & protecting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are trochar style chest drains?

A
  • Fenestrated with/without stylet. Stylets blunt or sharp.
  • Most commonly placed under GA
  • Need a subcutaneous tunnel as air leaks common
  • Rigidity means easy to place where you want them
  • Higher risk of tube-associated complications such as lung damage on insertion / pneumothorax»
    complication rates up to 58%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the benefits of a trochar sytle chest drain?

A
  • lots of different sizes available
  • Versatile, good for air or fluid, large bore means less likely to block
  • Robust / don’t collapse
  • Once learned, easy to place
  • Most transparent so easy to monitor for stuff that could clog the tube
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the disadvantages of trochar style chest drains?

A
  • Typically need a GA to place
  • Likely to have higher complication rate than narrow bore though published evidence minimal
  • Needs careful training
  • Need to learn a good suture technique for anchoring (2nd technique to learn)
  • Less comfy than narrow-bore
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are narrow bore/seldinger technique chest drains?

A
  • May cost more for the actual tube than a trocar , but may be cheaper to place as no GA
  • Not as important to have a subcutaneous tunnel as placement technique less invasive / air leaks less likely
  • Lots of fiddly bits in the packet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the advantages of using narrow bore / Seldinger technique chest drains?

A
  • No GA
  • Easy to place
  • Easy to secure
  • Versatile
  • More comfy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the disadvantages of using narrow bore/seldinger technique chest drains?

A
  • May not cope with pleural fluid / block e.g. pyothorax
  • Smaller sizes difficult in our patients as can be overlong meaning either too much inside the chest (prone to
    kinking) or too much outside (vulnerable to patient interference)
  • Not as rigid can end up in weird placement: can be difficult to position cranioventrally as not as rigid as the trocar drains
  • May not be able to do the normal SQ tunnel in a large patient as introducer catheters not that long
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are pleuralport chest drains?

A

the ones that look a bit like a stethoscope, used for palliatve care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what equipment will you need for closed chest placcement of a drain?

A
  • Sterile prep (clippers, scrub, surgical spirit, sterile gloves +/- drape)
  • Anaesthetic kit and monitoring as appropriate
  • Local for narrow bore
  • General for trocar
  • Assistant
  • Chosen chest drain, pre-measured for length
  • Scalpel & blade
  • Basic instrumentation (Rat-toothed forceps, needle holders, scissors, sterile swabs)
  • Fenestrated drape
  • 3-way tap
  • Syringes (size depends on volume to be drained)
  • Extension set
  • Kidney dish / jug
  • Suture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how do you secure a chest drain?

A

in-built anchor flanges and simple interrupted sutures
external drain-securing sutures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how do you manage a chest drain?

A
  • Nursing
  • Drainage
  • Infection
  • Analgesia
22
Q

what types of drainage is there for chest drains?

A

intermittent and continuous

23
Q

what is intermitten drainage of the chest?

A

drained usually every 4-6 hours depending on RR/dysponoea

24
Q

what is continuous drainage of chest drains?

A

drain is continously draining

25
Q

how do youreudce the risk of infection for a patient with a chest drain?

A
  • Aseptic technique at all times
  • Good bandage hygiene
  • Early identification for culture rather than just giving antibiotics
26
Q

what analgesia can be given for a hospitalised patient with a chest drain?

A
  • Local e.g. lidocaine
  • Systemic opioids e.g. methadone / buprenorphine
  • Local down the chest drain e.g. bupivacaine
  • CRIs e.g ketamine / lidocaine (no lidocaine in cats)
  • Paracetamol injection (dog only)
27
Q

what analgesia can you give to a patient who has gone home with a chest drain?

A

NSAID or oral paracetamol for dogs

28
Q

what are there complications that can arise from a patient with a chest drain?

A
  • Failure to place
  • Failure to drain
  • Patient
  • Iatrogenic
  • Introduction of infection
29
Q

why might a drain failure to drain after placement?

A
  • Inadvertent /accidental removal (kennel door, stood on by patient)
  • Tube disconnection
  • Tube obstruction (e.g. pleural, mediastinum, clots, pus)
  • Tube kinking
  • Tube slipped out a little. care not to break sterility
30
Q

what issues can arise with placement of a drain?

A
  • Unable to place
  • Incorrect placement (went caudal not cranial; didn’t enter the thorax; stuck in mediastinum)
  • Logical to check X-Ray post placement
31
Q

what patient interference can cause a drain not to drain properly?

A
  • Removal / chewing!
  • Whole thing or part? Foreign Body? Chewing a hole in it?
32
Q

what iatrogenic reasons might there be if a drain isnt draining properly?

A
  • Haemorrhage / Haemothorax check PCV & look for a difference
  • Heart / lung damage
  • Inappropriate / premature removal&raquo_space; recurrence
  • Nerve damage – Phrenic / Horners
  • Pneumothorax
  • check connectors
  • check fenestration
  • Pyothorax - aseptic technique
  • Seroma
  • Subcutaneous emphysema
  • Often around skin incision, can use antibiotic ointment to plug! Care with size of incision, should be snug
  • Check position of fenestrations
  • Self-resolves once tube removed (air reabsorbed)
33
Q

why might you keep a chest drain in?

A
  • Ongoing treatment via the drain
  • Clinically significant production of fluid/air
34
Q

why might you remove a chest drain?

A
  • Complications
  • Resolution of issue
  • Ongoing need for drainage
35
Q

what are the four main options for thoracic surgery?

A
  • Left, lateral, intercostal thoracotomy
  • Right, lateral, intercostal thoracotomy
  • Ventral, sternal thoracotomy / sternotomy
  • Thoracoscopy
36
Q

what are the important notes to rememebr with a intercostal thoracotomy?

A
  • defined next by numbered rib space
  • Less painful than sternotomy
  • Need to be sure that condition can be treated with unilateral surgery
  • Need to be sure of the correct side to approach
  • Need to be sure of the correct intercostal space to use
  • Left vs right
  • Where the organ is more accessible e.g. distal oesophagus (FB) => left side; PDA => left side
37
Q

what are the things to rememeber with a sternotomy?

A
  • More painful
  • Better for exploratory thoracotomy
  • Better for bilateral conditions
  • Not so good for if the problem is in dorsal thorax
38
Q

what are the things to remember with a thoracoscopy?

A
  • Least painful
  • Steep learning curve
  • Specialised equipment
  • Some limitations in which procedures can be safely completed using a scope.
  • rapid recovery
  • reduced visualisation
39
Q

how would a sternotomy be performed?

A
  • Dorsal recumbency
  • Midline approach
  • Osteotomy with saw blade
  • Exploration of left and right sides
  • Place chest drain under visual guidance
  • Closure with metal wire or sutures
40
Q

how would you lcip for a lateral thoracotomy?

A
  • Clip correct side of chest
  • Wide clip, long cranial –caudal
41
Q

how would you clip for a sternotomy?

A

from thoracic inlet to mid abdomen

42
Q

how would you clip for a thoracoscopy?

A

fully clipped in case have to convert to open

43
Q

how would you position for lateral thoracotomy?

A
  • Front legs +/- back legs loosely tied out of the way
  • +/- sandbag under chest
44
Q

how would you position for a sternotomy?

A
  • Dorsal recumbency
  • Legs tied loosely out of the way
  • May need cradle and/or sandbags to stabilise if narrow chested
45
Q

how would you position for a thoracoscopy?

A
  • Can be done in both lateral and dorsal recumbency depending on the procedure
46
Q

what are sternotomy instruments used for?

A

breaking through bone

47
Q

what are tissue forceps used for?

A
  • For atraumatic tissue handling
  • For atraumatic, fine dissection
  • For clamping vessels prior to ligation
48
Q

what types of retractors are there?

A

handheld or self-retaining

49
Q

what miscellaneous equipment would you need for thoracic surgery?

A

▪ Laparotomy swabs
▪ Wire or thick suture (1 PDS, 0 PDS)
▪ Suction
▪ Pre-selected chest drain & connectors
▪ Tourniquet
▪ Pledget sutures
▪ Vessel loops

50
Q

what types of lung lebectomies can be done?

A
  • Partial lobectomy (part of a lobe)
  • Total lobectomy (one entire lobe)
  • Pneumonectomy (one half of the lungs) = surprising how well they manage with only half a lung > expands to
    fill the chest
51
Q

how would you leak test a lung during surgery?

A
  • Fill the chest with warm saline
  • Suction on standby
  • IPPV
  • Check for air bubbles
  • Suction fluid back out once happy

ACVN - SURGICAL NURSING (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions