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Drainage is carried out in order to remove fluid, blood or air from the pleural cavity, as well as to eliminate mediastinal displacement, lung expansion, which can provoke hemodynamic type disorders.
Drainage of the pleural cavity
The procedure is carried out exclusively with the help of an assistant – the doctor will not be able to diagnose on his own.
Drainage is performed using drainage cups containing sterile water, thoracic drainage catheters, a needle holder, scissors, two clamps, two packs of silk suture threads, a scalpel, a needle with orange and green pavilions, a ten-millimeter syringe, and a local anesthetic. You will also need sterile dressings.
The patient must give informed consent for the procedure. The patient must be prepared before draining. The first condition is an empty stomach, it is forbidden to eat food at least twelve hours before the planned manipulation. After a general examination, the doctor without fail prescribes a number of examinations: ultrasound diagnostics, radiography or CT, UAC indicating the number of platelets, a blood test for a group and the presence of blood diseases, a blood test for hepatitis and AIDS.
With planned surgery (occurs extremely rarely), the patient is prohibited from taking anticoagulant drugs at least a week before drainage. The procedure begins with correct patient positioning: the catheter is inserted into a peripheral vein, the patient is comfortably placed on a healthy side with an arm raised up from the side of the drain. Sometimes drainage is done in a sitting position.
Next, the doctor determines the place for the introduction of drainage. The main condition is its introduction along the upper costal edge. With pneumothorax – 5-8 intercostal space in the middle of the axillary line, less often the second intercostal space is used. In the presence of non-encapsulated fluid – 5-8 intercostal space along the axillary line and nothing else. With encysted hydrothorax or pneumothorax, drainage is introduced in accordance with the placement of the “bag” with liquid (it is imperative to correctly establish the localization).
The doctor marks the puncture site with a marker. This place is treated with a local anesthetic (patients with CNS disorders may be given general anesthesia).
Indications and contraindications for drainage
Among the indications for puncture of the therapeutic and diagnostic type and drainage of the pleural cavity in the presence of ultrasound control, it is worth noting:
- the patient has artificial lung ventilation and there is no way to move the patient to a sitting position;
- the presence of limited pleurisy and a small amount of effusion.
Particular attention should be paid to patients:
- in which blood diseases are visualized;
- with the presence of congenital pathologies of the central nervous system, cardiovascular system and lungs.
The procedure is prescribed only if there are direct indications and there are no contraindications. The procedure can also cause the following complications: damage to the intercostal vessel (as a result, causes severe bleeding), improper placement of the drainage tube (causes severe pain), infection.
Drainage must be performed as quickly as possible so that less air enters the chest cavity and does not cause the lung to “fall”.
Drainage methods
Depending on the pathology, the doctor prescribes a specific drainage method. Properly selected method significantly increases its effectiveness:
- Redon’s vacuum method – the medical bottle is hermetically sealed with a nylon cap. The jar contains boiling water. The bottle is connected to the drainage tube, and in the process of cooling the water, a self-outflow is performed inside the pleural accumulations. This method allows you to remove about one hundred and eighty milliliters of liquid.
- Subbotin’s method – two sealed vessels are used, the fixation of which is carried out one under the other. Between the vessels there is a dense connecting tube. The upper vessel contains water, the lower one is empty. Under the influence of gravity, the water gradually overflows from the upper vessel to the lower one, while creating a vacuum, which allows you to pump out all the excess pleural fluid.
- Closed vacuum method – a sealed container and Janet syringe are used. Through the use of a syringe, air is pumped out. The tube is connected to a sealed container and the liquid is vacuum pumped out. It is important to create a perfectly sealed vessel space.
- Active suction is the most effective method, which involves the use of a water jet or electronic pump. A feature of this method is not only the effective pumping out of the liquid, but also the rapid contraction of the technological wound.
The method is determined by the doctor, taking into account the characteristics of the patient’s body and the stage of the disease, as well as the availability of the necessary equipment and a sufficient level of doctor’s skills. We recommend choosing clinics with experienced and highly professional doctors.
Installation and removal of pleural drainage
The doctor makes a small incision in the intercostal space, carefully and quickly inserts the drainage tube, fixing it with a U-shaped suture. Further, depending on the drainage method, they are connected to the container tube. The tube is fixed stably along the body to ensure fluid self-drainage.
After repeated CT scan results show that there is no fluid and air in the chest cavity, the doctor prescribes the removal of the drainage tube. It is important not to pinch the tube during the removal period. First, the adhesive bandage is removed, the sutures are gently and quickly loosened, and the drainage is removed. It is important to remove the tube without loosening, with one movement of the hand, at this moment the patient must hold his breath.
The resulting wound is sutured and a bandage is applied. Dressing and treatment of the wound is carried out every day, while the doctor pays attention to the condition of the sutures and the patient’s well-being. With a positive outcome of the procedure (without recurrence and negative consequences), the sutures are removed on the tenth day.
After surgery, complications may occur in the form of recurrent pneumothorax or hydrothorax, subcutaneous emphysema, empyema, pulmonary edema, and bleeding. In order to timely detect a complication and eliminate it, the patient is required to be in the hospital under the close supervision of doctors.