How to place a thoracic drain

Søren Boysen

doi:10.22233/9781910443521.16.13

British Small Animal Veterinary Association , e121 (2015); https://doi.org/10.22233/9781910443521.16.13

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How to place a thoracic drain

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Speaker: Søren Boysen
From: BSAVA Congress Proceedings 2015
Stream: How to…
Lecture Type: Veterinary streams
Item: pp 173 - 175
DOI: 10.22233/9781910443521.16.13
Copyright: © 2015 British Small Animal Veterinary Association
First broadcast: April 2015

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Figures

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Figure 1:

Have assistant pull skin 10–15 cm cranially (maintain sterile field). Ensure tension is maintained until after the tube is placed. Following tube placement, releasing the skin forms a tunnel over the tube (protects insertion site from contamination and leakage). © 2015 British Small Animal Veterinary Association

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Figure 1: Have assistant pull skin 10–15 cm cranially (maintain sterile field). Ensure tension is maintained until after the tube is placed. Following tube placement, releasing the skin forms a tunnel over the tube (protects insertion site from contamination and leakage).

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Figure 2:

Make a small skin incision through the dermis/epidermis at the seventh to ninth intercostal space (be sure to incise the latissamus dorsi muscle, either at this stage or during blunt dissection). © 2015 British Small Animal Veterinary Association

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Figure 2: Make a small skin incision through the dermis/epidermis at the seventh to ninth intercostal space (be sure to incise the latissamus dorsi muscle, either at this stage or during blunt dissection).

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Figure 3:

Bluntly dissect subcutaneous tissue and underlying tissue at the cranial border of the rib to the level of the intercostal muscles (avoid the vessels and nerves along the caudal rib). Try to avoid entering the pleural space during dissection. © 2015 British Small Animal Veterinary Association

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Figure 3: Bluntly dissect subcutaneous tissue and underlying tissue at the cranial border of the rib to the level of the intercostal muscles (avoid the vessels and nerves along the caudal rib). Try to avoid entering the pleural space during dissection.

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Figure 4:

Place a Christmas-tree adapter with PRN/three-way stopcock at the open end of the chest tube (prevents air entering pleural space during placement). Trocar tubes (e.g. Argyl) facilitate passage through tissue – place in a gentle/controlled fashion to prevent trocar lacerating the lungs. © 2015 British Small Animal Veterinary Association

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Figure 4: Place a Christmas-tree adapter with PRN/three-way stopcock at the open end of the chest tube (prevents air entering pleural space during placement). Trocar tubes (e.g. Argyl) facilitate passage through tissue – place in a gentle/controlled fashion to prevent trocar lacerating the lungs.

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Figure 5:

For non-trocar chest tubes (i.e. red rubber) use haemostats (Kelly or Halstead) to grasp the tip of the tube (align haemostats parallel to tube with the tip of the closed haemostats just beyond the tip of the tube) and push haemostats (with tube) through intercostal muscles into the pleural space. Assistant is still holding the skin. © 2015 British Small Animal Veterinary Association

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Figure 5: For non-trocar chest tubes (i.e. red rubber) use haemostats (Kelly or Halstead) to grasp the tip of the tube (align haemostats parallel to tube with the tip of the closed haemostats just beyond the tip of the tube) and push haemostats (with tube) through intercostal muscles into the pleural space. Assistant is still holding the skin.

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Figure 6:

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Figure 6: Enter pleural space during the expiratory phase of respiration (decreases risk of lung injury).

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Figure 7:

Once in the pleural space, open haemostats and advance tube to premeasured length. Direct tube ventrally for fluid and dorsally for air. Remove haemostats without removing tube. © 2015 British Small Animal Veterinary Association

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Figure 7: Once in the pleural space, open haemostats and advance tube to premeasured length. Direct tube ventrally for fluid and dorsally for air. Remove haemostats without removing tube.

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Figure 8:

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