Minimal drain surgery of the pleural cavity or pleural opening is in order to bring water or gas from the pleural cavity by placing the pleural drain through the chest wall.
1. Why do you have to have minimal pleural cavity
Normal pleural cavity is a virtual cavity produced by pleural leaves and organ leaves. Normal pleural cavity pressure is a negative pressure of about -2 to -4 mmHg, which changes with inhalation and exhalation. For some reason the appearance of epidemics, gases, blood,… in the pleural cavity alters the negative pressure in the pleural cavity affecting respiratory function. The lungs do not perform the function of providing oxygen to the whole body leading to the manifestation of shortness of breath even respiratory failure. Therefore, the minimal pleural opening technique is a procedure aimed at releasing the pleural cavity from pressure caused by gas or water, returning the pleural cavity to its original state of a negative pressure virtual cavity by placing drains through the chest wall.
2. Minimum pleural opening in which
- Pleural effusion in large quantities
- Pleural effusion in patients with clinically unstable symptoms
- Pressure pleural effusion
- Recurrent pleural effusion
- Traumatic pleural effusion
- Pleural effusion due to the procedures of the physician into the pleural cavity such as tumor biomass, pleural effusion.
- Pleural bleeding after injury or after the procedure
- Pleural eal fistula
- Pleural effusion caused by cancer
- Rapid recurrent pleural effusion
- Causes pleural stickiness through the conductive sonde
- Pleural effusion
- Pleural nourishment
- Minimal pleural conduction after thoracic surgery.
There are no absolute contraintraines.
Relative contraintoctraint when pleural conduction:
- Hematoma disorders, hem bleeding: prothrombin rate <50% và/hoặc số lượng tiểu cầu <50G/l.
- Damage to the skin into the chest of the pleural opening area.
4. Implementation procedure
The process must ensure four principles: closed, aseptic, one-way and continuous suction with a control pressure of > -20cm H2O and < -30 cm H2O.
- Determine the location of the conduction: Based on a computer ctracic film, or chest X-ray to select the patient's position when performing the procedure.
- Proceed to pleural opening:
- Disinfection of the flow zone
- Anesthesia in the pleural opening area. Anesthesia of the chest wall in layers, from the skin in to the leaves into the pleura. Using an anesthetic needle to probe the pleural cavity
- Make skin incisions and scales along the inter-rib cavity along the banks on the ribs to avoid damage to the inter-rib nerve vascular bundle. The incision is wide enough to get the drain
- Use a non-lumpy pan to separate each layer of the muscle into the chest along the muscle fiber that separates all the way to the leaves into the pleura then punctures the pleural cavity with the nose
- Insert the drain into the pleural cavity through the newly opened hole. For pleural effusion, the direction of the drain is front and top, and for pleural effusion, the direction of the drain is back and down
- Fixed circulation
- Connect the other end of the drain to the suction machine with suction pressure of -20cm H2O.
5. Note during the booking of the save
- After the drain connects to the suction system with the right pressure, drain all the volume of the solution and calculate the amount of translation by the hour.
- If the flow does not translate, check if the conductic flow is not. If the column of drains in the drain oscillating according to the patient's breathing proves that the drain remains drained and the drain has run out.
- Check if the lungs are hatching after the flow by: Clinical examination to assess the patient's condition, lung scan to check.
6. Some complications may occur during minimal pleural cavity resulsive surgery
- Chest pain.
- Bleeding due to puncture of inter-rib nerve vessels: surgical intervention if necessary.
- Mistakenly poking into neighboring organs (lungs, liver, spleen, stomach ,…) it is necessary to avoid the need to master the anatomy position, accurately determine the location of the pleural opening based on X-ray film, thoracic computer cirlitral layer, pleural cavity ultrasound.
- Overwhelmed by fear: this is a common accident.
- Acute pulmonary edema: can occur when sucking high pressure, the translation is too fast and numerous.
- Infection due to non-compliance with the erile rule in the procedure.
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