Vet360 Issue 5 Volume 2 | Page 32

Article sponsored by Petcam® SURGERY SURGERY Thoracostomy Tube Placement Dr Ross Elliot BVSc MMedVet (Surg) Bryanston Veterinary Hospital, 011 706 6023 Thoracocentesis and thoracic drain placement are lifesaving procedures in small animal practice and veterinarians should acquaint themselves with the technique and have basic equipment packs available for those emergency situations. These cases are often not initially stable enough to be referred. Emergency treatment is often lifesaving - the cause of the problem can then be determined at greater leisure. Indications A thoracic drain serves to remove air or fluid from the thoracic cavity. This will restore the negative pressure essential to normal respiration and alleviate pulmonary collapse. Initial management of thoracic effusions or pneumothorax is thoracocentesis, this is therapeutic and diagnostic as the fluid or air removed provides valuable information as to the underlying cause. The removal of the fluid and air will alleviate the respiratory compromise that has been caused by the pleural accumulation. In patients where repeated thoracocentesis is required, a thoracic tube should be placed. In an emergency patient in respiratory distress with fluid or air accumulation in the pleural cavity there are no true contra-indications to placement of the thoracostomy tube. One can consider thoracocentesis to drain some of the fluid to allow stabilisation of the patient prior to placement of the thoracostomy tube. A butterfly catheter is helpful here, especially in smaller animals such as cats, as the needle can be controlled and held still against the patient whilst syringes are swopped over at the other end of the tubing to drain the chest. Where there is a large amount of pleural fluid or air there is no longer a negative pressure within the pleural space - so it is not necessary to worry about a 3way stopcock when you start draining. As the pleural space empties of fluid - you will notice the fluid start to suck back in through the catheter tube - indicative of negative pressure developing. At this point you need to be more careful an