Puncture of the pleural cavity

Pleural puncture is understood as a procedure in which a laceration of the pleural cavity is performed in order to diagnose, or perform a therapeutic manipulation that can save a person's life. Most often used in the event that a person has accumulated pleural fluid, or effusion. Pleural puncture is often needed for edema, wounds, severe inflammation, and cardiac edema.

The purpose of pleural puncture

It all depends on what purpose the doctor pursues by performing the procedure. In the diagnosis, the internal organs are examined, liquid media are taken for further analysis. This gives a chance to fully study the pathology, to make additional laboratory and instrumental studies. If the doctor suspects a malignant neoplasm, a biopsy is performed, during which the biological material is collected for further histological examination. To therapeutic puncture resorted to if there is a need to have a therapeutic effect on a person, for example, the introduction of medications, air elimination. The effectiveness of therapy increases dramatically, because with this method, drugs are injected directly into the inflamed area, which increases the accuracy and bioavailability of any agent, the rate of exposure increases, and the need, dosage is significantly reduced.

Indications for the procedure

The main indication is the accumulation of fluid exudate in the pleural cavity. Diagnosis is based on ultrasound, percussion, and radiographic examination data .

Necessarily carried out with inflammation of the pleura, intrapleural bleeding, severe swelling. Sometimes the need for conduction occurs when there is effusion on the background of heart failure.

Pleural puncture with pneumothorax

If a person develops pneumothorax, the puncture should be performed immediately. It is carried out according to the standard procedure, without any differences and limitations. The only exception is that the liquid and air are evacuated from the cavity by means of a special syringe or pleuroasciration.

Sometimes there is a need to conduct only air drainage. For example, with valve pneumothorax, if a person inhales, air continuously enters the pleural cavity. Reverse drainage is not provided, so the tube is not clamped after the operation is carried out. The patient needs hospitalization.

[1], [2], [3]

Pleural puncture with hydrothorax

Hydrothorax is a severe condition in which pleural fluid accumulates in the pleural cavity. It can be both a transudate and an exudate. Another pathological fluid may also accumulate, including blood. The liquid can accumulate in the event that a person is injured, or with an intensive inflammatory process. Sometimes a tumor can stimulate excessive fluid production. It is advisable to subject the pumped liquid to histological, bacteriological analysis in order to evaluate its composition, basic parameters. This is an important diagnostic procedure, which makes it possible to think clearly about the tactics and strategy of further treatment. After removing the fluid, the pleural cavity should be thoroughly rinsed. To provide therapeutic effect, the necessary medicines, antiseptic drugs are introduced.

Pleural puncture with pleurisy

It is necessary, often even urgent, especially when the amount of inflammation is massive. Be sure to be performed when there is severe dyspnea. If the median shadow on the roentgenogram is displaced, it is also necessary to perform a puncture. In an emergency, no preliminary examination is required, training is also practically not conducted. The main purpose of the procedure is to reduce the amount of liquid.

Pleural puncture with exudative pleurisy

Under exudative pleurisy is meant a type of inflammation, which is accompanied by an intense accumulation of fluid. During the operation, special tools are used that suck up the contents, wash the cavity with antiseptic solutions. Special medicines are also being introduced. The procedure is carried out while the patient is in a sitting position .. If the patient feels unwell. Or is in serious condition, it is advisable to put it on a healthy side. From the head side, the operating table slightly goes down, which helps to prevent the development of air embolism.

Indications for pleural puncture in chronic heart failure

Patients suffering from various pathologies of the heart and vascular system make a risk group for the development of pleural effusion. The operation can be carried out urgently, or in a planned manner. With a planned puncture, preliminary training is carried out, which includes an electrocardiogram and other studies of the heart and blood vessels, which makes it possible to prepare the body, avoiding many complications such as hemothorax, hydrothorax. Manipulation for a person with heart failure is necessary if pain occurs during deep inspiration and exhalation, a strong cough, a feeling of bursting and burning. The appearance of frequent reflex cough and asymmetric chest displacement, respiratory disturbance and displacement of the mediastinum, are a sign that a person has a pleural fluid and urgent measures are required. The development of severe edema and stagnant phenomena, empyema, requires the urgent removal of fluid. Local administration of medications is carried out.

Preparation

Psychological preparation for the procedure assumes paramount importance. This is the responsibility of the nurse. It should explain the essence, adjust it to a positive outcome, maintain confidence in it.

It is important to be friendly and cute to the patient, showing respect to him, referring to his name and patronymic. If a person knows the essence of the procedure, it roughly represents how and in what order it will pass, it will be much easier to transfer. Ignorance always causes more fear and panic. The patient should understand what results the doctor plans to obtain and for what, in fact, a procedure is needed. The patient must undergo preliminary studies, thermometry.

An obligatory stage is premedication, during which the patient is prepared for anesthesia. An anesthesiologist is consulted. He examines the patient, conducts the necessary laboratory tests, then selects appropriate medicines.

Methods of pleural puncture

There are many different methods by which you can remove pleural fluid from the cavity. Each of them has its advantages and disadvantages. The most common method is thoracocentesis, which is used primarily for severe vertebrates, pneumothorax, and blood accumulation in the cavity itself. Also used drainage cavity, the method of Bylau. Also active drainage is carried out by means of a rubber pear, flow-aspirating drainage.

[4], [5], [6], [7]

Diagnostic pleural puncture

Has found wide application in various fields of medicine: it is used by rheumatologists, traumatologists, pulmonologists. Oncologists also have to apply this procedure quite often. It is carried out for the timely detection of pathology, as well as the collection of biological material for further research. A fluid intake and a biopsy are performed, in which a piece of tissue is taken for further histological examination. A fluid can be a transudative, non-exudative pathology that causes an inflammatory process. For this purpose, the density of the obtained biological samples and other parameters are examined. After extraction of the biomaterial, it is subjected to further biochemical analysis. If an infectious process is suspected, a bacteriological, virological analysis is performed. If there is a suspicion that an oncological process is developing, a histological study is carried out.

Diagnostic studies are conducted quite often, since they are characterized by high information content. If necessary, the intracavitary blood, lymph, pus, air is examined. If there is bleeding or suspicion of its occurrence, a sample is also taken (take a sample, monitor it). This greatly facilitates life with severe pleural lesions, often saving a patient's life. Often, a diagnostic puncture is first performed, which, when a pathology is detected, becomes a therapeutic manipulation.

[8], [9], [10], [11], [12]

Puncture and catheterization of the pleural cavity

It is carried out with purulent-inflammatory processes to eliminate exudate, transudate, blood and air.

Kits for pleural puncture

Pharmacies sell ready-made kits that contain everything you need to conduct a puncture. The base of the kit is represented by a syringe and needles. The volume of syringes and the diameter of the needles vary, so you need to clearly know what exactly is required for the procedure. Also, the kit is equipped with special clamps, which are used to prevent air from entering the pleura. Each set includes 2 tubes for collection of biomaterial, a tray with a set of necessary tools. They are usually represented by tweezers, tampons, wadding sticks. Also in the kits are included the simplest preparations for skin treatment and first aid.

Pleurofics

It includes a syringe, needles of various diameters, clamps, test tubes for collection of biological material, tweezers, tampons and cotton swabs.

One-time set for pleural puncture

A set is designed for the realization of thoraconcentrations, punctures. They are used mainly when there is fluid in the pleural cavity, the development of purulent pathologies. The kit is represented by a tray with tools, syringes and puncture needles. Sometimes the kits are equipped with a solution of novocain for anesthesia, alcohol, various medical supplies.

Instruments for pleural puncture

Today, the pharmaceutical industry produces many sets, which include all the necessary tools for the procedure, as well as some medical products and medications. The advantage of such sets is that they are disposable, respectively, significantly reducing the risk of infection.

Needle for pleural puncture

The diameter of the needle usually varies widely. Are intended for connection with a syringe. The connection is made through rubber tubes. Sets for single use are intended.

Technique of the pleural puncture

First of all, it is necessary to give a comfortable position to the patient. The doctor may ask the patient to raise his arm, which will expand the intercostal space. If the patient is in serious condition, the procedure is performed in the supine position.

Algorithm for pleural puncture

Not only the doctor but also the nurse take part in the manipulation, since the patient needs support and special preparation for the procedure. Also, a doctor needs help, since it is almost impossible for one person to perform such a procedure. The first mandatory action is the decontamination of the site, which will be subject to puncture. For this, various antiseptic agents are used. At the same time, the usual solution of iodine, or chlorhexidine, proved to be the best. The treated area is then dried with a napkin.

The puncture site is anaesthetized, which can be achieved by administering novocaine. Then, with the help of a needle designed for pleural puncture, the doctor performs a pleural puncture. It is mandatory to use a rubber tube for tapping, which ensures the air outlet and prevents it from getting into the pleura of the pleura. Where exactly the puncture will be performed, the doctor determines on the basis of the diagnosis. With each disease, the puncture site is individual, in most cases determined by the localization of the fluid or the inflammatory process. If during the procedure began to appear fluid, similar to blood, or foam, you need to urgently finish the procedure, pull the needle out.

After all the fluid is pumped out, the needle is pulled out with neat movements, the puncture zone is pressed with a finger, and then treated with antiseptic solutions. The procedure ends with the application of a sterile tampon and a sterile dressing. If complications occur, resuscitation may be required, but this happens very rarely.

[13], [14], [15], [16]

Puncture site for pleural puncture

The choice is determined by the doctor, depends on the disease and the goal. If it is necessary to remove air, spend in the area of 2-3 intercostal spaces. If liquid removal is planned, it is done in the 7-8 intercostal area. In order to prevent the rupture of blood vessels, necessarily carried out on the upper edge of the ribs.

Pleural puncture along the edge of the rib

Traditionally, the puncture site is the upper edge of the rib, because it contains the minimum number of vessels and nerves. Puncture is done with a needle approximately 1 mm in diameter. First, an anesthetic is drawn into the needle, a neat puncture is performed, and the drug is injected at the puncture site. Then the needle is pulled out. Gradually introduce a second needle, a larger diameter, which is attached to the syringe. Through this syringe, the puncture and pumping out of the liquid is carried out. After the procedure, the needle is pulled out with a neat movement, The puncture site is treated with an anesthetic.

Pleural puncture by Bulau

This is a method that is used if necessary to drain the pleural cavity. The method is named after the pioneer. The sitting patient should have his arms crossed in front of the chest, the head is lowered on them. The legs are on a special stand, the back should be flat. The puncture is carried out in the lower part, at the base of the lung and allows to remove fluid from its diaphragmatic part.

A special kit is used to carry out the procedure, which includes a sterile tray, Bobrov's apparatus, a clamp, tweezers, scissors, a silk thread. For work apply fingertips rubber and gloves. A solution of furacilin is also used.

Pleural puncture in children

Algorithm procedures and training for children are no different from those for adults. The only difference is that for analgesia and premedication, a lower dosage of the drug may be required. Needles of smaller sizes are used. The duration of the procedure may be shorter. The depth of the puncture is much less than in adults, which is due to the anatomical features of the child's body. General anesthesia is used. Especially important is the psychological preparation and support of a small patient.

Contraindications to the procedure

The procedure is contraindicated in hemophilia - a violation of the blood clotting process. In urgent order, if the patient's life depends on this, there are no contraindications, it is carried out even in the unconscious state.

[17], [18]

Complications after the procedure

Can have serious consequences and complications. But sometimes this is the only way to save a patient's life. Dangerous development of pneumothorax, air embolism, in which there is a blockage of blood vessels with an air thrombus. A person can start to spit blood. At sloppy performance, there is a high risk of injury to the stomach. This is indicated by a cold sweat, which protrudes on the forehead of a person, a dizzy head. End such a condition can clogged blood vessels. Sometimes there are situations when it is not possible to conduct a procedure either, because a life-threatening condition may occur, in which removal of the lung is the only way to save life.

Complications are very frequent, but still, in general, statistics show that this procedure can not be canceled, since there are no alternatives to it. It gives an opportunity to save many lives. Due to its proximity, it is possible to accidentally pierce the lung, diaphragm, or other organ located nearby. There may be intrapleural bleeding or air embolism of blood vessels. From the puncture site, bleeding may occur. If there is any, the slightest complication, you must immediately stop the manipulation. The needle is urgently removed, the patient should assume a supine position. Urgent need a surgeon's help.

[19], [20], [21], [22]

Care after the procedure

It should be under the supervision of doctors at least 24 hours after the procedure. At the end of the manipulation, the doctor is delivered to the hospital ward on a gurney. In case of complications, he is in the intensive care unit.

[23], [24], [25], [26], [27], [28]

Reviews

If you analyze reviews, they can be both positive and negative. Many have serious enough complications, after which the patient is in the intensive care unit. In others, the procedure goes without any complications, the patient's condition improves dramatically. If the procedure is carried out with a diagnostic purpose - very informative, often develops into a curative one.

If you analyze the doctors' opinions about the procedure, you can note: they are often forced to resort to this procedure, especially in emergency situations, when there is a threat to life. Consider this method radical, but very effective, despite not very high risk of complications. There is no other alternative to this method.

Experts note that in many cases after such an intervention the pleura thickens. This leads to a sharp decrease in the respiratory volume. Sometimes it is possible to restore normal breathing only with the help of a special operation - decortication. During this operation, a part of the pleura is removed.

If you analyze the reviews of practitioners, you can note the following major complications: fainting and collapse, which occur as a result of local anesthesia, due to a sharp drop in intrapleural pressure, changes in vascular tone.

Pneumothorax develops when there is a breach of the tightness of the vessels, in case of a breach of the hermeticity of the working system itself, and also as a result of damage to the lung with a needle. There is a sharp pain, shortness of breath, pressure and burning sensation in the chest area. Breathing is weakened, or not at all audible.

Often there is a transition of serous pleurisy to purulent. At the same time, the patient's condition deteriorates sharply, intoxication occurs. The exudate becomes turbid, a purulent precipitate appears.

Often there is intrapleural bleeding from the intercostal vessels. If the pleural puncture is not performed correctly, you can damage the liver, spleen. Often there is an injury to the hollow organ, the development of diaphragmatic hernia. There is bleeding in the abdominal cavity. You can diagnose with ultrasound and emergency laparoscopy. With severe damage, hemostasis or laparoscopy is performed, depending on the severity of the pathology.