Page 2165 - Cote clinical veterinary advisor dogs and cats 4th

1082 Chest Tube Placement

Postprocedure Pearls
• Routine postanesthetic monitoring • In cats, tent the skin, and insert the needle
VetBooks.ir iatrogenic trauma (respiratory difficulty • Avoid overflexing the neck (may kink/
through the skin first.
• Monitor for neurologic deficits due to
or vestibular ataxia with puncture from
obstruct the endotracheal tube).
the cerebellomedullary cistern; paresis and
during recovery; procedural complications
proprioceptive ataxia with lumbar puncture). • Ensure adequate spontaneous ventilation
can result in hypoventilation.
Alternatives and Their
Relative Merits RELATED CLIENT EDUCATION
MRI (p. 1132) or CT scan: SHEETS
• Advanced imaging superior for the diagnosis
of structural lesions Consent to Perform Cerebrospinal Fluid Tap
• May be strongly suggestive of inflammatory Consent to Perform General Anesthesia
disease
• Typically used in addition to CSF analysis AUTHOR: Greg Kilburn, DVM, DACVIM
to fully evaluate disorders of the CNS EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
Serum infectious titers: Thompson, DVM, DABVP
• Systemic disease not necessarily reflective of
CNS disease
• For most inflammatory nervous system
diseases, no infectious agent is identified.
CEREBROSPINAL FLUID COLLECTION Same
animal. While clinician holds the needle, an assistant
collects the cerebrospinal fluid.

Chest Tube Placement Client Education Bonus Material
Sheet
Online

Difficulty level: ♦♦ • Catheter adapter ○ Aforementioned complications are more
• 3-way stopcock common with the trocar method.
Synonym • Injection caps • Tube migration or premature removal of tube
Thoracostomy tube placement • ± Continuous drainage device by animal
• 20-gauge orthopedic wire or plastic zip ties • Development of life-threatening pneumo-
Overview and Goal • Wire twister and cutter if using orthopedic thorax if tube becomes open to atmosphere
To provide means for frequent or continu- wire
ous drainage of fluid or air from the pleural Procedure
cavity Anticipated Time • General anesthesia (preferable) or sedation;
About 15-45 minutes lateral recumbency
Indications • Clip hair from lateral thorax: from axilla
• Pyothorax (p. 857) Preparation: Important cranially to last rib caudally and from dorsal
• Rapidly forming pleural effusion (p. 791) Checkpoints spine to ventral midline.
• Recurring pneumothorax (p. 797) requiring • Make 3-5 extra drainage holes in chest tube • Aseptically prep and drape area.
repeated thoracocentesis with scalpel blade if thick or purulent fluid • Using scalpel blade, make a small stab inci-
• Tension pneumothorax is present in pleural space (<50% of the sion in the skin over the highest point of
• Postoperative thoracotomy management diameter of tube). Be sure not to compromise the thorax at the ninth or tenth intercostal
the integrity of the tube with extra holes. space (ICS).
Contraindications • Monitor animal’s oxygenation with pulse • The assistant then pulls the skin cranially
Severe bleeding disorder (p. 433) oximetry during anesthesia and placement. several centimeters and holds the skin in that
• If tension pneumothorax is present, position. The chest tube will be placed into
Equipment, Anesthesia continuous evacuation of pleural space by the thorax through the seventh or eighth ICS.
• General anesthesia with intubation (ideally) thoracocentesis until chest wall is opened When the skin is released after placement of
or sedation can help stabilize animal. the tube, there is a SQ tunnel of 2-3 ICS
• Clippers over the tube. This helps prevent air or fluid
• Surgical scrub Possible Complications and leakage around the tube.
• #11 scalpel blade Common Errors to Avoid • Lidocaine can be injected into intercostal
• Local anesthetic (e.g., 2% lidocaine, 0.1- • Improper (SQ) placement of tube muscle at the tube insertion site, or an
0.25 mL/kg, SQ, maximum 7 mL) • Impaling the heart or lungs with the tube’s intercostal nerve block can be performed,
• Small surgical pack or sterile hemostats stylet/trocar injecting lidocaine just ventral and caudal
• Suture material (e.g., 2-0 to 3-0 nylon) • Pulmonary contusions to the transverse processes of the thoracic
• An assistant (if possible) • Placement of the tube into the abdominal vertebrae/head of ribs one space cranial and
• Thoracostomy tube cavity, with abdominal organ trauma caudal and at the site of insertion. Before

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