Page 182 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 12 · Pleural drainage techniques
Chapter 12 · Pleural drainage techniques

OPERATIVE TECHNIQUE 12.3
VetBooks.ir Chest drain placement in an open chest

PATIENT PREPARATION AND POSITIONING
The patient is anaesthetized and positioned in lateral recumbency for an intercostal thoracotomy (see also Chapter 11),
or dorsal recumbency for a median sternotomy.
ASSISTANT

One person is required to monitor the anaesthetic. A surgical assistant is optional.

ADDITIONAL INSTRUMENTS
Silicone chest drain (16–30 Fr); chest drain connector, three-way tap, two bungs, gate clamp; 20–50 ml syringe. A chest
drain is selected that is approximately the width of the mainstem bronchus (16 Fr for cats and tiny dogs; 18–24 Fr for
small to medium dogs; 26–30 Fr for large to giant dogs). The length of chest drain that will just place the tip of the drain
at the level of the second rib is estimated.

SURGICAL TECHNIQUE
Approach
A small skin incision is made with a blade at approximately the 10th intercostal space, about two-thirds of the way up
the chest wall.

Surgical manipulations
1 Insert a large pair of forceps under the skin and advance them in a cranioventral direction to approximately the
eighth intercostal space. Introduce the forceps into the chest with a controlled push, while intrathoracic structures
are protected by the other hand inside the chest.
2 Open the tips of the forceps and grasp the end of the chest drain.

3 Retract the chest drain and forceps together through the chest wall and skin incision.
4 Arrange the drain so that its tip lies at approximately the level of the second rib and all of the side holes reside
within the chest.
5 Close the thoracotomy incision before the chest is drained.
6 Preplace a gate clamp on the chest drain and attach the drain to a connector, three-way tap and syringe.

7 After the syringe drainage, place two bungs on the three-way tap and secure the drain to the chest wall by means
of a Chinese fingertrap suture.

POSTOPERATIVE CARE
• A dressing is placed over the site of chest drain insertion and held in place by a chest bandage.
• The dressing and bandage must be changed and all the connections checked at least once daily.
• The animal must wear an Elizabethan collar to prevent interference with the drain.
• Animals with chest drains should have constant, ideally continuous, supervision: to ensure security of the tube
connections; to observe for changes in respiratory rate and effort; and to prevent interference with the drain.

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