Pleurocentesis

Description:

The pleurocentesis is a puncture of a pleural cavity, that is the cavity located between visceral and parietal leaves of a pleura.
Usually in a pleural cavity liquid at various diseases accumulates – at a tumor of a lung or pleura, at pleurisy, at tuberculosis, at cardiac hypostases, etc.
As the main indication to a pleurocentesis serves availability in it of liquid which can be defined at ultrasonography of a pleural cavity, or at a X-ray analysis. It is also possible to determine liquid level at percussion of a pleural cavity.

Indications to a puncture of a pleural cavity are also: pleurisy, intrapleural bleedings, a pleura empyema, transudate in a pleural cavity at hypostases.

The diagnostic pleurocentesis is carried out in a dressing room, and at heavy patients - in chamber.



Technology of carrying out pleurocentesis

For performance of a research use a needle 9-10 cm long, with a diameter of 2,0 mm with abruptly slanted (to 60 °) an edge. By means of an adapter - a rubber tubule the needle is connected to the 20th gram syringe. The adapter in process of filling of the syringe with the contents removed from a pleural cavity is periodically pressed the tool. This reception is necessary for prevention of penetration of air in it. As an adapter use of specially made double-thread faucet is rather convenient.

Punktirut a pleural cavity in position of the patient sitting with the hand taken aside and placed on a support. In such position the back costal and phrenic sine occupies lower parts of a pleural cavity.
The puncture of a chest wall is carried out in the VII-VIII mezhreberye on back axillary, or scapular lines. In case of exudate encystment the place introduction of a needle to a pleural cavity is defined, being guided by results radiological or ultrasonography.

So, step-by-step technology of carrying out pleurocentesis:

1) We gather novocaine of 0,5% in the syringe. 2-gram is the best of all to take at first the syringe. And to take him novocaine completely.
Remember: the area of the piston of the syringe is less, the pleurocentesis will be less painful. Especially it concerns those cases when you do a pleurocentesis at children.

2) We pierce skin and at once we begin to premise slowly novocaine, slowly pressing on the syringe piston, also slowly advancing a needle further – in muscles and soft tissues of a chest wall.
Remember: the aspirating needle is entered in the planned mezhreberye, being guided by the upper edge of an edge. If  to enter a needle on bottom edge, then it is possible to injure an intercostal artery, and it is very dangerous in view of not stopping bleeding (fig. 2) from it

3) We feel the elastic resistance of the fabrics located in the field of an intrathoracic fascia. And at the time of penetration of a needle into a pleural cavity the feeling  of "free space" appears.

4) The return movement of the piston in the syringe take contents of a pleural cavity: blood, pus, chyle or other look exudate. This the first - a visual estimate of result of a pleurocentesis is important in the diagnostic relation.  

5) We change a fine needle from the one-time syringe by which did anesthesia, on thicker, reusable, we connect to it through an adapter a hose from a suction machine and again we puncture a chest wall in already anesthetized place. Also we pump out exudate from a pleural cavity by means of a suction.

As a rule, the diagnostic puncture is transferred to the medical procedure including full removal of pathological contents, washing of a pleural cavity antiseptic drugs, introduction of antibiotics, drainage with accession of system for preparation of autologous blood in hemothorax cases.