thoracentesis

1. Diagnostic puncture: Determine the fluid in the thoracic cavity; determine the nature or cause of the effusion by puncture fluid test and case check. 2. Therapeutic puncture: reduce the intrathoracic pressure by pumping or pumping; injecting drugs into the thoracic cavity to treat empyema, pleurisy, artificial pneumothorax and so on. Treatment of diseases: empyema and pleural effusion Indication 1. A large amount of pleural effusion or gas accumulation, puncture and withdrawal of liquid or gas to reduce the pressure on the lungs or large blood vessels, improve breathing or circulatory disorders. 2. Pus in the pleural empyema, reduce poisoning, prevent further development of empyema, and can check the pus such as culture and drug sensitivity test to guide treatment. 3. Extract the pleural effusion for testing to determine its nature to assist in the diagnosis and differential diagnosis. 4. Injecting drugs (antibiotics, anti-tumor drugs, adhesion agents, etc.) into the pleural cavity by pleural puncture for local treatment. Contraindications 1. There are severe outbreaks, tendency to clotting, significant reduction of platelets or anticoagulant therapy with heparin and coumarin; 2. Large hemoptysis, severe tuberculosis and emphysema; 3. Patients who are unable to cooperate are also relatively contraindicated. If necessary, sedatives or basal anesthesia may be given for pleural puncture. Preoperative preparation Before the operation, the patient should be explained the purpose of the puncture to eliminate the concern; for those with mental stress, lOmg (diazepam) or 0.03 g of codeine can be given to the sedative pain half an hour before surgery. Those with a history of drug allergy need to do procaine skin test sensitivity. Surgical procedure 1. Position: The patient takes more seats. Facing the back of the chair, the arms are placed on the back of the chair and the arm of the headrest to widen the gap between the ribs. If you can't sit up, you can take the semi-recumbent position and lift the upper arm of the affected side. 2. Puncture site: Puncture is selected in the most obvious part of the chest percussion. It is usually taken from the shoulder line or the 7-8 intercostal space of the posterior line; sometimes it is also selected in the 6-7 intercostal space of the midline or the 5th intercostal space of the front line. For puncture points. Encapsulated effusion can be determined by X-ray or ultrasound examination. The puncture point can be marked on the skin with a cotton swab with a gentian violet. 3. Check whether the puncture needle is unobstructed, and the latex tube connected with the puncture needle is first clamped with a vascular clamp to prepare for puncture. 4. The operator fixes the puncture point skin in the left hand, and the right hand holds the puncture needle along the upper edge of the rib (if the chest is punctured, the puncture at the midpoint of the intercostal space) slowly penetrates until the resistance suddenly disappears, the syringe is attached, and the vascular clamp is released. The pleural fluid is pumped, and the assistant assists in fixing the needle with a vascular clamp and cooperates with loosening or clamping the latex tube. During the operation, the patient's reaction should be closely observed, such as dizziness, paleness, sweating, palpitations, chest pressure or severe pain, fainting and other pleural allergic reactions; or continuous cough, shortness of breath, cough foaming, etc. Immediately stop the pumping and subcutaneous injection of 0.1% adrenaline 0.3-0.5ml, or other symptomatic treatment. complication 1. Blood chest: may be caused by incorrect puncture site, piercing the intercostal arteries and veins, sometimes the cause is unknown. Treatment: 1 If pleural hemorrhage is found during the chest water, the chest water should be stopped. 2 lying on the side of the disease. 3 Observe the patient's pulse, blood pressure, 1-2 times per hour, such as no change after 4 hours, you can extend the observation time. After 4, you can continue to pump chest water. 2. Pneumothorax: The end of the needle is clamped at the end of the needle, leaking into the air or due to wearing the visceral pleura. Treatment: According to the amount of pneumothorax. Because the skin is not clamped and leaks into the air, try to get out. Because of the visceral pleura, it should be treated according to spontaneous pneumothorax. 3. Puncture mouth bleeding: press with sterile gauze and tape to fix. 4. Chest wall cellulitis and empyema are not strictly caused by disinfection when puncture, need to be treated with antibiotics, a large number of empyema can be closed drainage. 5. Air embolism is rare, more common in artificial pneumothorax treatment, the condition is critical, can cause death.