Puncture of the pleural cavity

Puncture of the pleural cavity (thoracocentesis) - puncture of the chest wall - is performed for therapeutic and diagnostic purposes. When diagnosed, it is determined:

1. Is fluid in the pleural cavity a transudate (edematous fluid collecting in body cavities) or exudate (secretion from small blood vessels accumulating in the extravascular space).
2. Does the liquid contain lymph, pus or blood.
3. Chemical, bacteriological and cytological composition of the pleural fluid.

When is puncture of the pleural cavity prescribed?

Indications for therapeutic puncture of the pleural cavity are:

• removal of air with a tight or closed pneumothorax;
• pumping out pleural effusion;
• the introduction of medications.

Procedure of the thoracocentesis

When preparing for puncture pleural cavity necessarily do chest radiography. The procedure of thoracocentesis is performed using local anesthesia , for which Novocaine solution is used. Anesthetized with puncture soft tissues and intercostal muscles. Thoracocentesis is performed as follows:

1. The patient sits down to rest his back, or lies on a healthy side. The hand from the side where the puncture will be done is placed on the opposite shoulder or on the head.
2. Puncture of the pleural cavity with hemothorax to remove blood or hydrothorax to pump fluid is done in the 7th - 8th intercostal space along the scapular or posterior axillary line.
3. The needle may not enter the pleural cavity, and if it rests against the rib, it is raised together with the skin. The feeling of a needle failure testifies that the needle has got where follows - in a cavity.
4. On the needle put on a transitional rubber tube.
5. With hemothorax and hydrothorax, aspiration of pleural contents is carried out. After the tube is full, it is clamped, emptied and injected again until the entire contents of the pleural cavity are removed. If the liquid is difficult to evacuate, then try to achieve an increase in the outflow rate. To this end, it is recommended to change the position of the patient's body or to connect a low-pressure suction to the catheter.
6. At the end of the procedure, an antibiotic is injected into the cavity.
7. Needle sharp movement is removed.
8. The puncture site is treated with a disinfectant solution, covered with sterile gauze.

At the end of the procedure, a chest x-ray is performed to determine if the pleural cavity is better and no complications have occurred.

With pneumothorax, puncture of the pleural cavity for air removal is carried out in a similar way, but there are some peculiarities in the technique of the procedure:

1. In pneumothorax, puncture is performed in the 2nd - 3rd intercostal space along the upper edge of the rib by the mid-incision line.
2. After the trocar (a needle with a large lumen) penetrates into the pleural cavity, the stylet is removed and, closing the hole in it, a drainage tube clamped by the clamp is inserted, for 5-6 cm into the interior.
3. The drainage tube is fixed with a plaster or seams, a sterile bandage is applied around it.
4. The drainage is put on a fingertip with a notch, so that the air passes in one direction - from the pleural cavity.

Those patients who are recommended for diagnostic or therapeutic purposes to puncture the pleural cavity are concerned: how much does it hurt?

And in fact, the procedure is rather painful. A study conducted in one of the specialized departments showed that, on average, patients assess pain at a procedure of 8-6 points on a ten-point scale, depending on the pain threshold . Therefore it is important that the puncture is made by an experienced doctor. Also it is reliably known that the smaller the area of ​​the syringe piston, the less painful the procedure.