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How I Place a Chest Drain
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The best way to manage patients with pleural space disease is by evacuation of the air or fluid within it. In the short term this can be easily accomplished using needle thoracocentesis. Where longer term drainage is required e.g. pyothorax, placement of a thoracic drain should be considered.
Chest Drains
Chest drains come in a number of forms and can be placed using a variety of techniques which is in part related to the diameter of the tube. In emergency patients use of the least invasive technique is preferable to prevent patient morbidity. Choices include tubes placed over a stylet and tubes placed via a modified Seldinger technique.
Placing a drain
When placing tubes of large diameters anaesthesia is typically required, it is preferable to stabilise the patient with needle thoracocentesis prior to anaesthesia. Care should be taken in the case of pneumothorax to prevent further injury to the lungs with over exuberant positive pressure ventilation. Thoracic tubes should be placed in a sterile manner; a large area of skin should be clipped and prepared. The veterinary surgeon should scrub up and preferably wear sterile gloves. The site of placement will be determined by the cause of pleural space disease. In pneumothorax the tube should be placed in the dorsal half of the chest, where there is pleural effusion the tube should be placed ventrally. Typically the tube should enter the chest in the 7th or 8th rib space.
I have found the use of the modified Seldinger technique extremely useful for placement of thoracic drains in both dogs and cats, and have found them to function well in pyothorax, pneumothorax and effusions of ovvher causes. As these catheters are small (14G) they may function less well when effusions are extremely thick. However because they are small they can be placed in dogs without sedation, cats will require some degree of sedation depending on their temperament.
Placement is simple. An intravenous catheter is placed into the thoracic cavity and the stylet removed. A wire is placed through this catheter and then the catheter is removed. Finally the thoracic drain is “rail roaded” over the wire into the chest. Placement is confirmed with radiography.
All thoracic drains should be maintained cleanly to prevent infection and should be bandaged in place to prevent patient interference.
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