PLEUROCENTESIS

From Big Medical Encyclopedia

PLEUROCENTESIS (late lat. pleuralis relating to a pleura; a puncture) — a puncture of a chest wall and a parietal pleura by means of a hollow needle or a trocar for the purpose of diagnosis (a diagnostic puncture) or treatments (a medical puncture). Diagnostic tasks are often combined with medical.


Indications to Pct — exudative pleurisy, an empyema of a pleura, a hydrothorax, a hemothorax, a chylous hydrothorax, spontaneous or traumatic pheumothorax.

Less often the pleurocentesis is made at suspicion on tumoral defeat pleurae . By means of Pct suck away air, blood, pus, a chyle from a pleural cavity, and also make its washing and introduction to it of various pharmaceuticals (antiseptic agents, antibiotics, proteolytic enzymes, fibrinolitik, hormones, antineoplastic means). Through a trocar in a pleural cavity: it is possible to carry out a plastic drainage for constant suction of air and liquid, administration of medicines.

Usually the puncture is carried out in position of the patient sitting; the head and a trunk of the patient at the same time shall be inclined forward, and the shoulder on the party of a puncture is taken away up and forward that allows to expand intercostal spaces. The head and a hand of the patient should be supported.

With extensive cicatricial processes in a pleura and lungs at which danger of injury of veins of a lung and developing in this regard of an air embolism of a brain is not excluded it is safer to patient to carry out Pct in position of the patient lying on the dressing or operating table which head end is a little lowered.

Pct, as a rule, produce under local anesthesia 0,5% solution of novocaine (10 — 15 ml).

For removal of liquid of a pleural cavity the puncture is done in VII or the VIII mezhreberye between average axillary and scapular lines; for suction of air — in II or the III mezhreberye on the sredneklyuchichny line. The place of a puncture is specified by means of percussion, by auscultations and roentgenoscopies. The chest wall is punctured on the upper edge of an edge in order to avoid damage of the intercostal vessels and a nerve located along its bottom edge. Apply a thick long needle to Pct, to-ruyu connect to the syringe by means of the crane or a rubber tube.

At suction of air or liquid from a pleural cavity before disconnecting the syringe, on a rubber tube impose a clip or close the crane. In process of removal of pleural contents sometimes change the direction of a needle a little. Evacuation of a large amount of air or liquid from a pleural cavity shall be made slowly not to cause the bystry shift of a mediastinum.

the Diagrammatic representation of optional versions of the wrong introduction of a needle during a pleurocentesis: 1 — the needle is entered into tissue of a lung; 2 — the needle is entered into a pleural cavity over a fluid level; 3 — the needle is entered into unions between leaves of a pleura of a rebernodiafragmalny sine; 4 — the needle is entered through a costal and phrenic sine into an abdominal cavity.

During the carrying out Pct heavy mistakes — a puncture of a lung, a diaphragm, a liver, spleen, stomach (fig.) are possible, complications in the form of intrapleural bleeding, an air vascular embolism of a brain can be observed. During the developing of intrapleural bleeding during Pct in the syringe there is scarlet blood, and at the available bronchopleural fistula there is a pneumorrhagia. At a puncture of a lung cough, and in case of introduction to tissue of a lung of pharmaceuticals — their taste in a mouth is observed. At penetration of a needle into a stomach in the syringe air and gastric contents can be found. The air vascular embolism of a brain can be shown by sharply arising blindness on one or both eyes, in more hard cases — a loss of consciousness, spasms.

Prevention of complications — careful definition of the place of a puncture and direction of a needle, strict observance of a .metodika and equipment of Pct.


M. I. Perelman.

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