Pneumothorax How to prevent recurrence after thoracostomy drainage

Thoracostomy is often used for traumatic or spontaneous pneumothorax, hemothorax, empyema and thoracotomy after thoracotomy Its purpose is to exclude fluid, gas and blood in the chest cavity, mainly by using the semi-recumbent position and the expansion of lung tissue itself and the patient's effective cough, using the pressure difference during breathing, the gas or liquid in the pleural cavity is drained to the outside of the body, so as to achieve the best effect.

1. Why connect the water seal bottle:

After thoracic cannulation, a water-sealed bottle is attached to one end of the tube. The purpose of the water-sealed bottle is that under normal conditions, the pleural space pressure changes with breathing. The pressure during the general exhalation is 3 5 cm water column.

The pressure during inhalation is about 8 10 cm water column, in order to prevent the air from being sucked into the chest cavity by negative pressure, causing lung collapse, so it should be connected to the water seal bottle.

2. How to observe the fluctuation of water column:

After chest cannula drainage, it is important to observe the fluctuation of the liquid column in the water seal bottle; Check whether the drainage tube is unobstructed, mainly observe whether the water column of the long glass tube of the water seal bottle fluctuates up and down with breathing and gas discharge, and when the drainage is normal, the water column fluctuates up and down about 4 6cm.

The magnitude of the water column fluctuation reflects the size of the residual cavity and the magnitude of the negative pressure in the chest cavity.

Several common anomalous water column fluctuations:

1) The water column fluctuates too much, more than 6 10cmh2o. Suggests atelectasis or large residual cavity. Air bubbles in the water seal during deep breathing or coughing indicate pneumothorax or excess air accumulation in the residual cavity.

2) There is no fluctuation or weak fluctuation of the water column, indicating that the drainage is not smooth, indicating that the pipeline is discounted, pressurized, blocked, or there is air leakage in the lumen on the water column, and the medical staff should be notified when applying.

2) The water column is stationary in the horizontal plane, which mostly indicates that the lung has been re-expanded, the negative pressure in the chest cavity is established, and the water column is stationary under the horizontal plane. Suggests positive intrathoracic pressure and pneumothorax.

3. How to determine the effect:

Pay attention to the overflow of air bubbles in the water-sealed bottle and the changes in their properties.

For example, after 42 96 hours of closed chest drainage, no fluctuation of the water column in the water seal bottle is observed, no gas escapes, and the water column in the glass tube is significantly higher than the surface of the bottle by more than 5 10cm, indicating that most of the gas has been discharged, and the negative pressure in the chest cavity is restored, if the pipeline blockage can be ruled out, the breath sound on the affected side is restored by auscultation, and the lung has been re-opened by X-ray fluoroscopy or radiograph, and the drainage tube can be clamped for 24 36 hours, and the drainage tube can be pulled out if there is no air accumulation in the pleural cavity.

Once a pneumothorax is present, it is possible at any time. At this time, you should pay attention to rest and sleep, do not work too much, should not bear weight, and prohibit smoking and drinking.

Eat more protein during the recovery period, which is beneficial to the wound. At the same time, you can consume some foods with high fat, which is beneficial for pneumothorax patients.

You can't play sports for one month after pneumothorax**. After this period of time, you can gradually engage in some light sports, and gradually participate in jogging and other events, step by step, to enhance your physical fitness.

When you start to carry your school bag, you should pay attention to avoid using the affected area to exert force, and gradually it will be nothing. Pay attention to protect the affected area, don't get hit hard, and finally wish you a speedy **!

Don't overthink it, the wound will heal in 7-10 days. I mean, what should I do, as soon as **, do a thoracoscopy**, it's a hundred. If you don't do it, most of them do.

The indications for closed pleural drainage are:

Patients with pneumothorax, hemothorax or empyema requiring continuous gas, blood or pus;

Those who make an incision in the pleural cavity. Closed pleural drainage method: according to the signs and chest X-ray examination, the location of air and fluid in the pleural cavity is determined, and the intercostal space of the middle grandson cannula is selected.

The fluid is in a low position, and it is generally drained by the 8th intercostal line between the midaxillary line and the posterior axillary line. The air accumulates upwards, and it is advisable to drain the anterior upper pleural space, and the second intercostal space of the midclavicular line is often selected. The patient is taken in a semi-recumbent position, and after chest sterilization, the whole thickness of the chest wall is infiltrated with 3 5 ml of l procaine solution in the selected intercostal space.

Make a small incision about 2cm long, insert a vascular clamp to separate the muscle layer, and then divide into the pleural cavity along the upper edge of the ribs, and insert a rubber tube or plastic tube with side holes into the pleural cavity 4 5 cm through the incision, and its outer end is connected to a sterile water seal bottle or drainage device. The incision is sutured, and the drain is secured.

The standard water-sealed bottle for draining the pleural cavity is a large-mouth bottle with a volume of several liters, with two holes in the rubber stopper, and inserted into a long and short glass tube. The lower end of the long tube is inserted into the bucket to 3 4cm below the horizontal plane, and the lower mouth of the short tube is far away from the horizontal plane, so that the space in the bottle is communicated with the atmosphere. To use, attach the pleural cavity drain to the long glass tube of the water-sealed bottle.

After it is connected, it is seen that the water column in the long tube is 8 l0cm above the water surface, and moves up and down with the breath. If the water column does not move, it indicates that the drainage tube is not passable. To keep the lumen open and avoid blockage, squeeze the drain frequently.

Record hourly or daily fluid drainage. In order to maintain a certain negative pressure, remove gas and fluid from the pleural space, and promote lung expansion, a negative pressure suction device can be added. Traditionally, a water-sealed bottle is connected to a negative pressure regulating bottle.

The adjustment bottle is also a large-mouth bottle with three holes in the rubber stopper and three glass tubes. Two short ones are connected to the short glass tube on the water-sealed bottle and the negative pressure suction device. The upper end of the long glass tube communicates with the atmosphere, and the lower end is inserted under the water surface (10 20 cm), and the negative pressure of suction is adjusted according to the depth of the water column.

At present, a variety of single-use plastic pleural cavity drainage devices are available for clinical application. Debate and grind.

After pleural drainage, if the water column stops fluctuating within 24 hours and no more gas or fluid is discharged, the drainage tube can be removed if the lung is well distended by x-ray. At the time of extubation, the patient is instructed to inhale deeply, hold his breath, quickly remove the drain, immediately cover the wound with petroleum jelly gauze, and fix it with adhesive tape, or tighten and tie the sutures that have been placed in the incision of the drain.

Key points of surgery for thoracostomy induction:

1) According to the specific condition, take the semi-lateral decubitus position or the semi-sitting position.

2) Transcostal intubation is mostly used. In tension pneumothorax, due to the urgency of the condition, a semi-recumbent position is often taken, and closed intubation and drainage are often performed in the second intercostal space of the midclavicular line according to clinical examination and chest x-ray.

3) Patients with pleural effusion can have a chest tube placed in the 6th and 8th intercostal midaxillary lines.

4) After chest disinfection, infiltrate the full-thickness chest wall with 3 5ml of 1 procaine or 1 lidocaine solution in the intercostal space of the selected swim mill.

5) Make a small incision about 2cm long, insert a vascular clamp to separate the muscle layer, and then divide into the pleural cavity along the upper edge of the ribs, and insert a rubber tube or plastic tube with side holes into the pleural cavity 4 5cm through the incision, and its outer end is connected to a sterile water seal bottle or drainage device.

6) Suture the incision and secure the drain.