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Questions and Answers
What is the main purpose of inserting postoperative drains?
Which of the following incisions provides good access to the anterior mediastinum?
What is the preferred position for the patient during an anterolateral thoracotomy?
Which of the following incisions is useful for the management of spontaneous primary pneumothorax?
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What is the main limitation of the anterolateral thoracotomy approach?
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Which of the following structures is cut or split during an anterolateral thoracotomy?
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In which intercostal space is the chest entered during an anterolateral thoracotomy?
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Which of the following patients is an anterolateral thoracotomy preferred for?
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What is the advantage of the axillary mini-thoracotomies approach?
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What is the main advantage of the median sternotomy approach?
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Study Notes
Chest X-ray and Pleural Aspiration
- A chest x-ray is used to assess the amount of residual fluid present and to exclude a pneumothorax.
- Pleural aspiration is used to drain fluid from the pleural space.
Pleural Drainage
- Pleural drainage is used to drain fluid from the pleural space.
- Equipment required for insertion of a chest drain includes:
- Chest drain between 22 F and 32 F
- 0.5% lidocaine 20 mL
- Underwater seal apparatus including bottle/active aspiration source
- Sterile water
- Surgical blade
- Small and large artery forceps
- Heavy suture (e.g. silk 0)
- Adhesive tape
Insertion of a Chest Drain
- The patient is positioned as for pleural aspiration.
- The insertion site is the fifth intercostal space in the midaxillary line on the affected side.
- The site is suitable for drainage of both a pneumothorax and a hemothorax.
- The procedure involves:
- Anesthetizing the skin and tissues down to the upper border of the chosen rib.
- Making a 2-3 cm transverse incision over the proposed site of insertion.
- Dissecting bluntly through the subcutaneous tissues and intercostal muscles.
- Puncturing the parietal pleura with the tip of the artery forceps.
- Sweeping the gloved index finger down the line of blunt dissection to free any adhesions.
- Guiding the drainage tube down the track with the index finger.
- Attaching the outer end of the drain to an underwater seal drainage apparatus.
- Closing the incision with interrupted sutures and a tight tie around the drain.
Pericardial Effusion
- A rapidly evolving effusion can lead to cardiac tamponade.
- Cardiac tamponade prevents the heart from filling in diastole, leading to a low stroke volume.
- To maintain cardiac output and blood pressure, there is a tachycardia and intense peripheral vasoconstriction.
- A pericardial effusion can be drained percutaneously through a catheter placed under echocardiographic guidance.
Thoracic Incisions
- Anterolateral thoracotomy:
- Performed with the patient in a dorsal decubitus position.
- Preferred in unstable trauma patients.
- The incision is under the breast, and the pectoralis major is cut or split.
- The serratus anterior is split, and the chest is entered in the 4th intercostal space.
- Access is more limited.
- Axillary mini-thoracotomies:
- Made through the axilla into the chest via the 2nd or 3rd intercostal space.
- Useful for the management of spontaneous primary pneumothorax.
- Median sternotomy:
- Gives good access to the anterior mediastinum, the heart, and great vessels, and both pleural spaces.
- The middle and posterior mediastinum, as well as the left lower lobe, are hard to reach.
Postoperative Drainage
- Drains are inserted to evacuate established collections of pus, blood, or fluid or to drain potential collections that may follow operation due to continued oozing of blood or inflammatory exudate.
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Description
This quiz assesses knowledge on chest X-rays, pleural aspiration, and chest drainage, including equipment required and insertion techniques. Relevant to surgical practices and medical procedures.
