Brainscape's Knowledge GenomeTM

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


See full index

Year 4 Small Animal Studies > Soft Tissue Surgery: Thoracostomy Tubes (Chest drains) > Flashcards

Soft Tissue Surgery: Thoracostomy Tubes (Chest drains) Flashcards

1
Q

When is thoracocentesis contraindicated?

A
  • Patient not appropriately stable
  • Ongoing haemothorax
  • Clinically insignificant volumes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  1. What lines the pleura?
  2. What is the purpose of fluid in the pleura?
A
  1. Mesothelial cell lining
  2. Lubriactes for ventilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the problem with pneumothorax?

A
  • Uncouples the coordinated movement of the thoracic wall and lungs during ventilation
  • Ventilation/perfusion/V/Q mismatch
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does pleural effusion reduce inspiration?

A
  • Decreases space for lung expansion- decreases tidal volume
  • Fluid accumulaiton- reduces diaphragmatic movement- decreasing ventilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the clinical signs of a pleural effusion?

A
  • Increasing severity of signs with rapid progression and/or larger volumes
  • Restrictive or paradoxical breathing pattern
  • Tachypnoea, dyspnoea/cyanosis
  • Orthopnoic posture
  • Diminshed cardiac auscultation
  • Lung sounds and thoracic percussion- reduced especially ventrally
  • Pneumothorax- hyper-resonant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the three methods of thoracic cavity drainage?

A
  1. Needle thoracocentesis- one off drainage/sampling

Repeated drainage/anticipated
2. Trochar thoractostomy tube
3. Wire guided small more multi-fenestrated thoracostomy tube (MILA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe needle thoracocentesis?

A
  • Pre-oxygenate ± sedation
  • IV catheter in place
  • Sternal recumbency
  • Aseptic preparation of lateral thoracic procecure- 7-9th IC
  • Dorsal 1/3rd intercostal: air
  • Ventral 1/3rd: fluid
  • Consider local: SC lidocaine
  • 3 way tap off before insertion
  • Butterfly needle parallel to chest wall, slowly advance through intercostal muscles
  • Open 3 way tap and aspirate pleural fluid contents
  • Turn off 3 way tapp before removing needle
  • Post-proceudre radiographs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What equiment is needed for needle thoracocentesis?

A
  • Aseptic preparation equipment
  • Butterfly needle or over needle catheter and extension tubing
  • 3 way tap
  • Syringes
  • Tests: EDTA tube (cytology), plain tube (C&S) and smear
  • Record volume obtained
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the complicatoins during placement?

A
  • Lung laceration
  • Pneumothorax
  • Haemorrhage
  • Iatrogenic infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What angle should the needle for thoracocentesis be inserted at and why?

What should be done if Frank blood is aspirated?

A

Parallel to the chest
Needle insertion at 90 degrees increases lung laceration risk

Frank blood:
Fresh bright red- iatrogenic haemorrhage will clot
Compare fluid PCV to patient PCV: haemothorax PCV > patients PCV, iatrogenic will =

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When should a thoracostomy tube be placed?

A
  • When repeated thoracocentesis is required
  • Following thoracic surgery
  • Medical managment of pyothorax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What can be done preop before a surgical thoracstomy tube placement?

A
  • Preoxygenate
  • Sedation or GA
  • Lateral or sternal recumbancy
  • Clip and prep from caudal border of scapula to caudal to last rib
  • Aseptic technique- risk of iatrogenic pyothorax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is a thoracostomy tube placed- basicaly for all tubes?
How is tube size selected?

A
  • Insertion into the chest through the 7th or 8th intercostal space
  • Cranial border of the rib- intercostal AVN on caudal aspect
  • Side of chest based on clinical or imaging findings- bilateral if massive effusion or pyothorax

Tube size:
* Internal diameter- 50% width of the intercostal space
* External diameter- mainstem bronchus diameter
* Length- 2nd to 7th/8th/9th ribs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the three tube types used for thoracostomy?

A
  • Trochar-type chest drains
  • Jackson Pratt fenestrated drain with trocar
  • Guidewire-inserted/MILA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What equipment is needed for thoracostomy tube placement?

A
  • Sterile gloves
  • Intercostal nerve block/local anaesthetic/lidocaine
  • Scalpel
  • Haemostat
  • Thumb forceps
  • Needle holders
  • Scissors
  • Tube clamp
  • 3-way stopcock
  • Tube equipment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How should local be given prior to thoracostomy tube placement?

A
  • Intercostal nerve block > intercostal nerves run caudal to ribs
  • Infiltrate puncture site/tunnel
17
Q

Describe the process of thoracostomy tube placement of a trocar-type chest drain

A
  • Skin incision over 10th or 11th intercostal space and tunneled cranioventrally
  • Tube held vertical at 7th or 8th intercostal space in one fist- small portion of sharp end between surgeons hand and thoracic wall
  • Tube inserted into the chest- forced into IC space with pressure on stylet
  • Tube placed parallel to thoracic wall and advanced off the stylet
18
Q

How can the trochar tube be inserted without the stylet?

A
  • Tube held between closed tips over 10th or 11th
  • Haemostat closed to penetrate thoracic wall pleura at 7th or 8th IC space, haemostat tips open, tube then advaced into thorax
19
Q

How is the thoracostomy tube held in place?

A

Fingertrap suture pattern

20
Q

What post thoracostomy tube placement care is needed?

A
  • Close monitoring for dislodgement or tube disconnection > pneumothroax
  • Hard elizabethan collar, body vest at all times
  • Multi-modal analgesia: opioids/NSAIDs/local anaesthetic
  • Monitor respiratory rate and effort
  • Monitor insertion site- subcutaneous emphysema, inflammation, discharge
21
Q

Describe the process of wire guided thoracostomy tubes?

A
  • Cannula insertion via 7th/8th intercostal space
  • Wire threaded into cannula
  • Hold wire, cannular removed
  • Dilator then fenestrated drain threaded over wire, remove the wire
  • Chest drain clamp and cap secured
  • Chest drain sutured in place
22
Q

How can tubes be drained differently?

A
  • Continuous- commercial systems/3 chambered suction apparatus
  • Intermittent- manual aspiration
  • Active/passive- heimlich valve
23
Q

What are possible post-placement complications of thoracic tubes?
How can they be prevented?

A
  • Discharge around tube site- aseptic technique, elizabethan collar
  • Accidental tube damage/removal (pneumothorax)- elizabethan collar
  • Tube blocking/kinking- appropriately secure tube
  • Subcutaenous emphysema or pneumothorax- trocar, create subcut tunnel, ensure tube fenestrations in chest
  • Damage to intra-thoracic structures- 7/8th IC space
  • Pain- analgesia
24
Q

When should a thoracostomy tube me removed?

A
  • Fluid drained <2ml/kg/day
  • Volume of air drained: none
  • Decide based on- status, disease process, diagnostics: radiographs, fluid cytology, culture

Year 4 Small Animal Studies (97 decks)

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