Therapeutic thoracentesis is performed according to two indications. First, it is resorted to in order to rid the patient of shortness of breath caused by pleural effusion; secondly, for oud Lenia pleural fluid, to be evaluated with the distance being under her lung. Although in the second case, thoracocentesis is actually performed for diagnostic purposes, it is classified as therapeutic, since a large amount of pleural fluid is removed. The role terapevtiche Skogthoracentesis in patients with pleural during limited hours is limited. Thoracentesis does not affect the main patolo Gia, causes the formation of pleural effusion, while the body of the patient appears to significant protein lichestvo. 2000 ml of pleural fluid containing protein in the amount of 5 g / 100 ml, the patient loses 100 g of protein. Nevertheless, therapeutic thoracentesis recom mended in cases of acute dyspnea and extensive pleural effusion, especially if the patient is contralateral mediastinal shift.
Repeated therapeutic thoracocentesis is indicated for patients with a malignant neoplasm accompanied by dyspnea and contralateral displacement of the mediastinum, if pleurodesis is not possible . In addition, a therapeutic thoracentesis produce patients with malignant pleural ful if and shortness of breath to make sure that the shortness of breath disappears after thoracentesis . Thoracentesis should be made to the Introduction drainage Denia and pleurodesis (see chap.?). Contraindications for therapeutic thoracentesis are the same as for Diagna -Terrorism.
When the therapeutic thoracentesis patient locat ditsya in the same position as when the diagnostic thoracentesis , exactly the same puncture site selected. In tab. 12 lists additional materials that may Pona achieve the therapeutic thoracentesis . Main fault Chiyo between therapeutic and diagnostic thoracentesis is that the therapeutic thoracentesis can not perform sharp needle. As the fluid removal easy and straightened, if you use a sharp needle, it is easy for harm. Therefore, therapeutic thoracentesis produce a plastic catheter or a blunt needle used for biopsy. If a puncture biopsy is necessary at the same time, then therapeutic thoracocentesis can be performed through a biopsy needle after performing the biopsy.
Methods of therapeutic thoracentesis with for strength plastic catheter ( intrakat ) is shown in Fig. 51. Upon receipt of pleural fluid in the syringe, on space filled with lidocaine as in diagnostic torakotsente se , is connected to the plastic syringe needle № 14 ( intrakat ). When continuous careful aspiration needle smoothly and PICs goad motivate the, until it reaches the pleural liquid STI. After aspiration of pleural fluid, disconnect the syringe The needle hole is temporarily closed with a finger so that the pneumothorax does not develop. Then a catheter No. 14 ( intracat ) is inserted through a needle and guided down to the costal and diaphragmatic sinus. The catheter should not be promoted, if the resistance is felt, since this may cause its damaging of or clogging. After introducing the catheter to the end of fire resistance of the needle to place the needle was carefully removed, the remaining Laa catheter in the pleural cavity.
Immediately after removing the needle, its end is covered with a clutch so that the needle does not cut through the end of the catheter. The catheter should not be output through a needle since the sharp end of the needle it can PWA dit. Immediately after removal of the needle catheter is necessary to close the drink on the skin of the patient so that he accidentally slipped out of the pleural cavity.
After introduction of a catheter into the pleural cavity, eject the needle and close the needle end of the catheter coupling attached to the end of the syringe, the closed three-way stopcock, and Chin aspirating pleural fluid. The advantage of the plastic catheter is that the absence of a needle into the pleural cavity eliminates the risk of damage to lay down one by its expansion. In addition, for a more complete removal of pleural fluid can be changed polo patientvoltage thoracentesis , an X-ray should be taken to ensure that the patient has not developed pneumothorax. If those therapeutically thoracentesis They performed mainly with Diag -terrorist purpose, after it is recommended to make dvusto eral X-rays at a position lying on its side to determine the amount of remaining fluid in the pleural cavity and differentiate pleural fluid from infiltration comrade and volume of lung. In some cases, at the end of thoracentesis before making rentgenologiche scattering investigation, it is recommended to enter the pleural of smallness 200-400 ml of air. The creation of this kind of iatrogenic > pneumothorax facilitates the determination of the thickness of the visceral and parietal pleura.
Permissible volume of aspirated pleural fluid. In therapeutic thoracentesis recommended Aspirate Vat no more than 1000-1500 ml of pleural fluid . That some limitation is due to the fact that in some patients after thoracentesis pulmonary edema develops at its expanded or hypovolemia .
We believe that the development of these complications associated with on underreporting of negative pressure in the pleural cavity during therapeutic thoracentesis . We have shown that it is safe to aspirate large number plevutral liquid when producing thoracentesis under cont pressure Lemma and terminate aspiration of fluid when the pressure falls below -20 cm water. Art . Measurement of intrapleural pressure can be performed using a U-shapedmanometer, as shown in fig. 52. When the aspiration plevu tral liquid drop rate intrapleural giving Lenia in different patients varies .
Changing intrapleural pressure pleural during injection of the liquid during therapeutic thoracentesis two pain GOVERNMENTAL malignant pleural involvement and two patients with shell nym light (crosses). Note the rapid drop in intrapleural pressure in patients with an armor-clad lung (From ).
the patient, nor the doctor performing thoracentesis , do not notice a significant drop in pressure . In our group of 52 patients, 13 (25%) had to stop thoracocentesis due to a drop in pressure below –20 cm iodine. Art. In 8 patients failed once to aspirate more than 4000 ml of pleural fluid without any adverse effects on pain Foot. Of course, if you are having distressing symptoms, mani pulyatsiyu must stop. These symptoms often all of a heavy cough, feeling of heaviness or bo whether chest. In the above group of 52 patients in the 5 SLE teas (10%) manipulation therefore had Terminated tit.
It should be noted that there is a slight correlation between the onset of symptoms and the drop in intrapleural pressure.