Pleural puncture
Pleural puncture is one of the classic surgical procedures aimed at evacuation of fluid or gas from the pleural cavity.
<3
hours
Preparation
1-10
minutes
Operation time
1-3
days
period
Complexity:
Низкая
Type of anesthesia:
Local anesthesia
Preoperative preparation:
Position of the patient on the table:
- Sitting, the head and trunk should be tilted forward, and the hand on the side of the puncture is raised and wound up behind the head
Technique of operation: Step 1.
Help the patient to take the necessary position (sitting, head and trunk should be tilted forward, and the hand on the side of the puncture is raised and wound up behind the head).
Technique of operation: Step 2.
Wash your hands and put on gloves.
Technique of operation: Step 3.
Treat the skin (alcohol, iodine).
Technique of operation: Step 4.
At the point of puncture at the site of the proposed puncture (as a rule with fluid accumulation: at 7-8 intercostal space in the middle axillary line, with pneumothorax: in 2-3 intercostal spaces along the middle clavicular line) perform infiltration anesthesia with 0.25-0.5% solution of novocaine or 0.5 - 1% solution of lidocaine to the peritoneum.
Technique of operation: Step 5.
Then the needle is in the direction strictly perpendicular to the chest wall along the upper edge of the underlying rib! advance into deeper tissues.
As the needle moves forward, it is necessary to prescribe an anesthetic solution.
As the needle moves forward, it is necessary to prescribe an anesthetic solution.
Technique of operation: Step 6.
Using a pointed scalpel at the site of the proposed puncture, make a cut (5 mm) of the skin and subcutaneous tissue.
Technique of operation: Step 7.
Take the puncture needle into the leading arm, pre-connect the needle through a special adapter to the syringe with an anesthetic or tube clamped by the clamp.
* In the presence of a trocar, the thoracocentesis is performed by him, then the stylet is removed and a drainage tube is inserted through the sleeve.
* In the presence of a trocar, the thoracocentesis is performed by him, then the stylet is removed and a drainage tube is inserted through the sleeve.
Technique of operation: Step 8.
Pull the skin with the needle in a strictly perpendicular direction to the chest wall.
Slowly but decisively, rotate the thoracic wall with pivotal movements (the moment of hit is the feeling of "failure into the void" due to the decrease in tissue resistance).
Slowly but decisively, rotate the thoracic wall with pivotal movements (the moment of hit is the feeling of "failure into the void" due to the decrease in tissue resistance).
Technique of operation: Step 9.
After removing the contents, the puncture site is re-treated with an antiseptic solution and sealed with a tissue.
Or the drainage tube is hemmed to the skin with both ends of a ligature pre-tied to the tube and attached to a pre-prepared extension tube.
Or the drainage tube is hemmed to the skin with both ends of a ligature pre-tied to the tube and attached to a pre-prepared extension tube.
Postoperative period:
Typical errors:
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Instruments
Access
- Scalpel, blade 11/21
- Needle Holder Geghar
- Needle cutting 3/8 40-50mm for leather
- Suture material (silk, kapron)
- Alcohol solution of iodine
Operative reception
- Troakar or puncture needle with mandrel
- Drainage tube with side openings
- The most convenient and safe are the special trocars with a safety flap and a side crane
- Forceps, anatomical, surgical
- Clamp
- Anesthetic solution (Novocaine 0.25-0.5% or 0.5-1% lidocaine solution)
Exiting the operation
- Syringe 10-20 ml with injection needle
- Capacity for collection of liquid