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Thoracocentesis and pleural drainage in horses
M. K. CHAFFIN
Department of Large Animal Medicine and Surgery, College of Veterinary Medicine, Texas A&M University,
College Station, Texas, USA.
lung laceration. If continuous thoracic drainage is a localised area of swelling may develop a t the
anticipated, a larger (24-32 french) indwelling chest tube thoracocentesis site that requires symptomatic treatment.
can be inserted (see pleural drainage). Mild pneumothorax caused by aspiration of air through the
A 3-way stopcock is attached to the teat cannula prior cannula is most frequently asymptomatic,because the air is
to insertion so as to avoid aspiration of air into the rapidly resorbed (Schott and Mannsman 1990).
pleural space. Some clinicians prefer to attach a 76.2 cm Rapid drainage of large volumes of pleural fluid may
catheter extension tube between the teat cannula and the result in third space fluid loss and resultant
3-way stopcock. The cannula is inserted through the skin, haemoconcentration. In man, hypoxaemia and acute
intercostal muscles and parietal pleura into the pleural pulmonary oedema may occur subsequent t o rapid
space. A slight to moderate amount of carefully drainage of voluminous effision (Jay 1985). 'Ib avoid
applied force is needed to insert the cannula haemoconcentration and pulmonary oedema, voluminous
through the intercostal muscle and parietal pleura. effusion should be removed slowly (unless there is
Care should be taken not to contact the underlying respiratory distress) and i.v. fluids should be supplemented
lung with the cannula. (Semrad and Byars 1989; Schott and Mannsman 1990).
When the pleural cavity is entered, a distinct release of
pressure is felt. Slight aspiration is then applied to Analysis of fluid
facilitate evacuation of pleural fluid. The orientation of the
cannula can be changed as needed to collect as much fluid Aliquots of pleural fluid should be collected in EDTA tubes
as possible. If the cannula is inserted directly into pleural and submitted for cytology, protein concentration and
fluid, drainage will commence as the 3-way stopcock is Gram's-stain (Cowell et al. 1987; Chaffin 1994). Samples
opened. If neither fluid drains out nor air rushes in, the in an heparinised syringe can be collected and submitted
clinician must consider 4 possible explanations: for biochemical analysis (pH, glucose concentration, LDH
activity) (Brumbaugh and Benson 1990). Other aliquots of
Fibrin or lung may be overlying the portals of the pleural fluid should be submitted for aerobic and
cannula anaerobic bacterial cultures (Sweeney et al. 1991).
The cannula may not be inserted completely through Analysis of pleural fluid is reviewed in detail elsewhere
the parietal pleura (Mair and Sweeney 1992; Chaffin 1994).
Site selection may have been incorrect
There may be insufficient pleural fluid to allow Pleural drainage via indwelling chest
collection (Chaffin et al. 1994a).
tubes
If the horse is not in respiratory distress due to
voluminous effusion, fluid should be allowed to drain Drainage of pleural effusion allows re-expansion of the
slowly using either slight aspiration or the inspiratory lung. In horses with pleuropneumonia, drainage
positive pleural pressure to force the fluid out through the facilitates removal of exudate, bacteria and cellular
cannula. As drainage subsides, caution should be debris. In horses with pleuropneumonia, parapneumonic
exercised to avoid aspiration of air into the pleural effusions are classified either as uncomplicated
space. A 76.2 cm extension set attached to the cannula (aseptic) or complicated (Chaffin et al. 1994b).
and allowed to hang downward helps prevent aspiration. Drainage is indicated when the parapneumonic
In normal horses, only a few ml of straw-coloured fluid
effusion is complicated. Indications of a
complicated parapneumonic effusion (Schott and
is obtained. In some horses with pleural effision, as much
Mannsman 1990; Chaffin et a2 1994b) include 1 or more
as 30-50 1 of pleural fluid may be drained. If fluid is
of the following characteristics:
excessive, the tubing can be extended over a bucket to
facilitate measurement of pleural fluid. When the procedure
Empyematous character
results in mild haemorrhage, the fluid will be blood-tinged; Putridodour
typically the fluid clears as more fluid is drained. When Cytologically-visible bacteria
blood discolouration is due to the underlying disease, the Positive bacterial culture results
fluid will usually remain blood-tinged throughout drainage Low concentration of glucose (<40 d d l )
(Schott and Mannsman 1989; Sweeney 1992; Mair and Low pH (<7.1)
Sweeney 1992; Chaffin and Carter 1997). When drainage High LDH concentration (>lo00 i d ) .
ceases, the cannula is withdrawn and a suture is placed
over the skin incision (Beech 1991). In some individuals, it may be difficult to determine
whether drainage is indicated. Each should be considered
Complications individually and serial evaluations of pleural fluid may
detect trends of progression or improvement that dictate
Complications from thoracocentesisare rare;however, initiation of drainage. In some horses, pleural drainage is
improper technique can result potentially in pneumothorax, indicated when there is a poor response to
lung laceration, haemothorax, cardiac arrhythmias, and conservative treatment or when the volume of
puncture of bowel, liver or heart (Beech 1991).Occasionally, pleural fluid results in respiratory distress.
108 Thoracocentesis and pleural drainage