CATHETERIZATION OF GRUDNOY CANAL

From Big Medical Encyclopedia

CATHETERIZATION OF GRUDNOY CANAL (grech, katheter probe; synonym: drainage of a chest channel, cannulate of a chest channel) — an operational way of introduction to a gleam of a chest lymphatic channel of a catheter for the diagnostic and medical purposes. One of the first To. of the item A. Cook in 1924

made Indications

Portal hypertensia, long mechanical jaundice, pancreatitis, peritonitis, a heart attack of intestines, a serious poisoning the concentrated alkalis and to-tami. More rare To. of the item is applied for the purpose of specification of the diagnosis at malignant tumors of various localization, leukoses, tuberculosis and an actinomycosis of internals.

Contraindications

the Hypovolemia, the expressed hypoproteinemia, inflammatory processes on a neck.

The equipment

Usually To. of the item is carried out under a local infiltration anesthesia. At its combination to other operations, and also in cases of an intoksikatsionny delirium operation is performed under the general anesthesia.

Position of the patient on the operating table — lying on spin with the head turned on 20 — 40 ° to the right and taken away back.

Fig. 1. The diagrammatic representation of ways of opening of a gleam of a chest lymphatic channel for the subsequent its catheterization: and — opening of a gleam of a channel after preliminary fixing of its walls piercing ligatures; — a puncture of a channel by means of mandrin conductor; in and — a puncture of a channel a needle with elastic mandrin dilator, with the subsequent introduction of a catheter between legs of mandrin; 1 — a brachiocephalic vein; 2 — an internal jugular vein; 3 — a chest lymphatic channel; 4 — a subclavial vein.
Fig. 2. The diagrammatic representation of fixing of a catheter in a gleam of a chest lymphatic channel in functional situation: 1 — in cervical department of a channel the plastic catheter which other end is hemmed to a periosteum of a clavicle is entered and strengthened by a ligature; 2 — the internal jugular vein delayed by gauze «handle»; 3 — the left grudino-klyuchichnosostsevidny muscle; 4 — a vascular hook; 5 — a clavicle; 6 — a breast. At the left the place of a skin section is below shown.

Section of skin do 4 — 5 cm long in a projection of the left grudinoklyuchichno-mastoidal muscle. Legs of this muscle stupidly part in the parties, baring a back surface of a venous corner (the typical place of a confluence of a chest channel). Grudnoy Canal is found by consecutive preparation of the veins forming a venous corner; to simplification of detection it in a wound is applied by various methods of contrasting (see. Grudnoy Canal ). Ways of opening of a channel are presented in the figure 1. Polyvinyl chloride catheters with a diameter from 1,5 to 5 mm are more often applied to catheterization. Fixing of a catheter in a gleam of a channel and to a periosteum of a clavicle in functionally advantageous position is shown in the figure 2. At the same time there are ways of fixing of a catheter allowing to keep a natural lymph flow that is important for carrying out (at indications) the managed drainage (partial limfovenozny shunting). Behind a catheter the careful leaving including its periodic washing by heparin is necessary.

Duration of assignment of a lymph is defined a wedge, expediency. At observance of all requirements To. of the item becomes the managed method of treatment of heavy patients for a long time (from 1 to 10 days).

Outcomes and complications

At portal hypertensia assignment of excess quantity of a lymph from a liver improves a hemodynamics in an organism that is clinically shown by reduction of the sizes of a liver, disappearance of ascites, the termination of bleeding from varicose expanded veins of a gullet and a stomach. To. of the item at mechanical jaundice allows to lower quickly the content of bilirubin in blood, to prevent development of hepatonephric insufficiency. Assignment of a lymph at a pancreatonecrosis reduces intoxication, prevents development of a fermentemiya. At poisonings acetic to - that and a heart attack of intestines To. of the item interrupts transport in blood of products of an intravascular hemolysis, bacterial toxins and biologically active agents. Complications are various: damage of vessels of a venous corner, the phrenic, wandering and returnable nerves at the left, loss of a catheter and education hron, limfofistula, inadequate completion of losses of protein, electrolytes, waters is possible. These complications are, as a rule, not dangerous and do not influence an outcome of the disease.


Bibliography: Topical issues of gastroenterological and cardiovascular surgery, under the editorship of Sh. A. Gulordava, page 84, Tallinn, 1976; P and c and about r and M. D., Tsatsanidi K. N. and Lebezev V. M. The managed drainage of a chest lymphatic channel, Surgery, No. 3, page 63, 1977; Pikovskiyd. L. y Alekseev B. V. Drainage of a chest lymphatic channel for outside assignment of a lymph, in the same place, No. 10, page 111, 1975; Archimbaud V.& Technique et serveillance du drainage du canal thoraci que sa terminaison, effectu£ en vue d’une transplantation gyopa1e, J. Urol. Nephrol., t. 75, Suppl. 12, p. 292, 1969; Cooke A. Lymphaticostomy in peritonitis, Brit. J. Surg., v. 13, p. 309, 1925— 1926; D u m o n t A. E. a. W i 11 e M. H. Clinical usefulness of thoracic duct cannulation, Advanc, intern. Med., v. 15, p. 51, 1969; We’rner B. Thoracic duct cannulation in man, Acta chir, scand., Suppl. 353, p. 1, 1965.

V. M. Buyanov.

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