Introductiona. Definition
Invasive action by inserting a hose or tube into the thoracic cavity by penetrating the muscular intercostalisb. Scope
Distribute both substances in the form of solids, liquids, air or gas from the chest cavityc. Operation Indication
- More than 30% pneumothorax.
- Pneumothorax residif
- Bilateral pneumothorax
- Hematothoraks more than 300cc
- Hematothoraks bilateral
- Hemato-pneumothorax
- Flail-chest
- Fluidothoraks is superb, with shortness of
- Chylothoraks
- Empyema thoracis after dipungsi unsuccessful or pus is very thick
- Post thoracotomid. Contra Indications:
- General
- Special (no)e. Diagnoses
Nof. Examination Support
- CXRTechnical operations
Installation WSD
1. Patients in a state of half sitting position (+ 45 °).
2. Carried out disinfection and closing with doek sterile operating field.
3. Do local anesthesia with 2% lidocain in infiltration in the area of skin to the pleura.
4. Places that will be installed drain is:
- Linea front axillary line, the ICS IX-X (Buelau).
Can be more proximal, if necessary. Especially in children because the location of the diaphragm
high.
- Linea medio-clavicularis (MCL) in the ICS II-III (Monaldi)
5. Created 2 cm long skin incision until the tissue under the skin.
6. Listed vertical mattress sutures anchoring is tilted to the side 0.1.
7. With tipped curved scissors or blunt clamp curved, subcutaneous tissue freed up the pleura, the pleural penetrated slowly until you hear a sucking sound, it means that the parietal pleura was opened.
Note: on hematothoraks will soon be spraying blood out, the pneumothorax, the air comes out.
1. Drain the trocarnya inserted through the hole towards the cranial lateral skin. When using the drain without trocar, then the end of the drain is clamped with a blunt clamp, to facilitate direct drain.
2. Should be checked first, if the drain is made or there are enough holes side length approximately the distance from apex to the aperture of the skin, duapertinganya.
3. Drain then pushed while playing a little lateral direction until the tip is below about lung apex (Bulleau).
4. After the drain in position, then tied with string fastener rotating double, ending with a slip knot
5. When used according to Monaldi drainage, the drain is driven downwards and laterally until the tip approximately mid-thoracic ronga.
6. Before the drainage pipe system connected to the reservoir bottle, it must be clamped first.
7. Drainage pipe is then connected to the reservoir bottle system, which will guarantee the re-occurrence of negative pressure in the intrapleural cavity, in addition will also accommodate sekrit out of the thoracic cavity.Complication
When done correctly, complications can be avoided. But it can also occur kutis emphysema, False route on the liver when installed too low on the right, especially in children because the location of the diaphragm is still highMortality
Very low morbidity, mortality 0%Post-Installation Care WSD
1. The patient is placed on a semi-sitting position (+ 30 °)
2. The entire drainage system: pipes, bottles, should be in neat, there are no riots arrangement, and can be immediately seen.
3. pipe that comes out of the thoracic cavity must be fixed to the body with plaster wide, orange to prevent wobble.
4. By using a transparent pipe, it can be seen the release of secretions. Must be maintained that the secretions out smoothly. When visible blood clots or other, must be milked until smooth again.
5. Every day should be the control piston AP photo to see:
- Lung condition
- The position of drain
- Other abnormalities (emphyema, shadow mediastonim)
1. The number on the bottle sekrit shelters should be calculated:
- Many sekrit out (every hour - every day)
- Kinds sekrit out (pus, blood, etc.)
7. In patients with respiratory physiotherapy has always done
8. Any abnormalities in the drain should be immediately corrected.Post-Installation Care WSD
1. The patient is placed on a semi-sitting position (+ 30 °)
2. The entire drainage system: pipes, bottles, should be in neat, there are no riots arrangement, and can be immediately seen.
3. pipe that comes out of the thoracic cavity must be fixed to the body with plaster wide, orange to prevent wobble.
4. By using a transparent pipe, it can be seen the release of secretions. Must be maintained that the secretions out smoothly. When visible blood clots or other, must be milked until smooth again.
5. Every day should be the control piston AP photo to see:
- Lung condition
- The position of drain
- Other abnormalities (emphyema, shadow mediastonim)
1. The number on the bottle sekrit shelters should be calculated:
- Many sekrit out (every hour - every day)
- Kinds sekrit out (pus, blood, etc.)
1. In patients with respiratory physiotherapy has always done
2. Any abnormalities in the drain should be immediately corrected.
Revocation guidelines
1. Criteria for revocation
- Sekrit serous, not hemorage
Adults: the amount is less than 100cc/24jam
Children - children: less number 25-50cc/24jam
- Lung expands
Clinical; sound right = left lung expands
Evaluation of chest X-ray
1. Condition:
- In the trauma
Hemato / pneumothorak who already meet both criteria, immediately revoked by the water-tight (air tight).
- In thoracotomi
a. Infection: 24h clamps to prevent resufflasi first, if either unplug.
b. Post operative: if it fulfills both criteria, langsug revoked (water-tight)
c. Post pneumonectomy: day-to-3 when the mediastinum is stable (does not need water-tight
1. Alternative
1. Permanent lung collapse, suction up to 25 cmH20:
- If both krieria met, the clamps first 24 hours, fixed baikà unplug.
- If unsuccessful, wait until 2minggu à dekortikasi
1.
1. Sekrit over 200cc/24jam: suspicion of thoracic Chylo (make sure the laboratory), keep up with 4minggu.
- If unsuccessful à Toracotomi
- If less than 100cc/24jam sekrit, clamps, and then revoked.Follow - Up
Aimed at the onset of further complications such as empyema, Schwarte, impaired respiratory function.
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