Closed drainage of the pleural cavity through the intercostal approach

1. Tension pneumothorax. 2. Traumatic middle and upper blood chest. 3. The empyema ineffective in medical treatment, especially those with bronchopleural fistula or esophageal pleural palsy. 4. After thoracotomy. Treatment of diseases: tension pneumothorax Indication 1. Tension pneumothorax. 2. Traumatic middle and upper blood chest. 3. The empyema ineffective in medical treatment, especially those with bronchopleural fistula or esophageal pleural palsy. 4. After thoracotomy. Contraindications The age of the body is weak, the vital organs such as the heart and lungs are poor, and the surgery does not restore hope. Preoperative preparation 1. Tension pneumothorax should be immediately given to the pleural cavity decompression, in order to obtain preparation time before surgery. 2. Traumatic hemothorax needs to be prepared for whole blood at the same time. Surgical procedure 1. After local infiltration of anesthesia into the parietal pleura, the needle is inserted a little, and the pleural cavity puncture is confirmed again. 2. Make a 2 to 3 cm incision along the intercostal space, and cut the skin and subcutaneous tissue in turn. 3. Use two curved hemostats to alternately and bluntly separate the chest wall muscle layer to the upper edge of the rib, and penetrate the parietal pleura into the pleural cavity between the intercostals: there is a clear sense of breakthrough at this time, and there is liquid spill or gas spray in the incision. mountain. 4. Immediately place the drainage tube in the pleural cavity. The side hole should be 2 to 3 cm in the chest. 5. Incision sutures 1 to 2 needles, and ligation and fixation of the drainage tube to prevent prolapse. The drainage tube is connected to the water seal bottle, and the interfaces must be tight to avoid air leakage. 6. The cannula can also be used to puncture the tube. After cutting the skin, the right hand holds the trocar, and the finger is fixed at 4 to 5 cm from the tip of the needle. As a sign of the depth of the piercing chest, the left hand fixes the skin at the incision. When the puncture needle enters the pleural cavity, there is a clear sense of breakthrough. 7. Exit the needle core, insert the catheter, and then exit the trocar while the tube is placed. To prevent the trocar from exiting, take the drainage tube out at the same time. complication Those who have a large amount of gas and fluid in the pleural cavity should be slow when opening the drainage. A rapid swing shift of the mediastinum or the occurrence of recurrent pulmonary edema occurs. After the condition is stable, gradually open the hemostatic forceps.

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