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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