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Chest tube thoracostomy

Chest tube thoracostomy

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Published by: 4gen_0 on Jul 08, 2010
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11/14/2013

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TOCACOSTOMIA PIPES
Dr. Francisco Ayes General Thoracic Surgery
GENERAL
The placement of a chest tube for
thoracostomy is a quick and safe procedure that is performed in the emergency ro
om.

THERAPEUTIC INDICATIONS
Drain air or fluid from the pleural space Introduction of sclerosing agents
for

prevent recurrence of effusion or pneumothorax in selected patients (chemical pl
eurodesis) thoracotomy to reduce systemic analgesia requirements
post instillation of local anesthetics
Prophylactic indications
Patient with rib fractures or emphysema
after subcutaneous trauma:

3. VMA will undergo 4. Will have surgery (Pr Positiva) 5. It will be moved from the emergency room for long periods of time (CT / US) 6. Will be transferred to another service center in July. Trauma patient with respiratory failure that can not be mobilized to remove dangerous or RX

CONTRAINDICATIONS
There are no absolute contraindications Atelectasis COPD - Emphysema pleur
o-pulmonary adhesions clotting disorders

Increased TP€Thrombocytopenia TTP
PROCEDURE
Individualization of patient risk / benefit balance ventilatory and hemody
namic Commitment
Chest tubes
It is generally recommended tubes 28F - 32F for
most indications thoracostomy
To empyema and hemothorax eventually
tubes recommended 36F - 42F
For pneumothorax, tube 12F - 22F are
appropriate
SURGICAL TECHNIQUE
The placement of a thoracostomy tube in
emergency conditions requires little or no requirement for placement
When possible:
explains the procedure to patient analgesia or sedation prior to placement
SURGICAL TECHNIQUE

Insertion usual:
5 ° EIC between LAA and LAM
5. Prevents muscle structures 6. More comfortable in July. Less Painful 8. More

aesthetic 9. Air or liquid drained
SURGICAL TECHNIQUE
Placement
Alternative: 2nd EIC LMC 4. Placement impossible, difficult or painful EIC May 5
th. Auxiliary drain 6. Wash system or instillation of thrombolytics
SURGICAL TECHNIQUE
For a proper
thoracostomy tube in the patient is supine MS high and behind the patient's he
ad near the edge of the bed or table rotated slightly forward
SURGICAL TECHNIQUE

Infiltrate the diagonal path of the tube forming a "tunnel" oblique
To determine the presence of air and / or liquid
Closure of thoracostomy or simple point Sarnoff
Suture "U" before the chest tube insertion
Fixation with one or two loops of thread
Closing point "U" to remove the tube
Fixation with two sutures
RECOMMENDATIONS

Avoid gauze bandages around the tube Cover with transparent adhesive bandage
s or
leave uncovered
Set the tube to the abdominal wallEnsure the connector to connect carpule

drainage system
PLEURAL DRAINAGE SYSTEM
PLEURAL DRAINAGE SYSTEM
PLEURAL DRAINAGE SYSTEM
PLEURAL DRAINAGE SYSTEM
Air flow direction of the water seal suction chamber to force the system out neg

ative Pr
Water Seal
1

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