Pleural puncture with hydrothorax technique vikonannya. Draining pleural emptying according to Bulau.
pleural puncture(Late late Pleuralis is carried to pleura; synonymic pleurocentesis, thoracocentesis) - puncture of the thoracic wall and partial pleural effusion, or a trocar with the method of diagnostics (diagnostic puncture). Diagnostic staff often have fun with friends.
Pleural puncture with a head rank in case of exudative pleurisy, pleural effusion, hydrothorax; In addition, they are viral with hemothorax, chilothorax, spontaneous or traumatic pneumothorax, which grows in the presence of pleural fluff. You will be allowed to establish the manifestation of the pleural effusion of exudate, transudate, blood, poodr, and rhyme for bacteriological, cytological and physical-chemical dosage. For the additional help of P., the item Vіdsmoktuyut pathological in the pleural emptying, healthy prominence and injecting lykarski into it (antiseptics, antibiotics, proteolytic antibiotics, fibrinolytic drugs). P. item.Vykonuyut also when applied pneumothorax from lykuvalnoyu abo diagnostic method.
Call the punctuation to sit in the position of the sick person. When buying a line in the pleural empty, the head and tulub of the sickly guilty were nailed forward, and the shoulder on the sides of the puncture was brought up the hill and forward, so that it was possible to expand the middle edges; the head and hand of the ailing man. In case of great cicatricial processes in the pleura, P. bezpechnis should be carried out in the position of a sick person lying on a healthy body; The head end of the bandaging abo to the operating table is slightly lowered. Such a camp allows me to become ill with an embolism in the brain in the event of a wound in the lung and getting into it.
Pleural puncture should be performed in accordance with the rules of asepsis, as a rule, before muscle anesthesia is 0.5%, novokain (10-15 ml). For a visual appearance from the pleural empty space, puncture in the eighth intercostal space between the middle groin and shoulder blades with lines; for a change of heart - in another, or the third, mid-clavicular line. I will make a puncture to clarify for additional percussion, auscultation and fluoroscopy. Pierce the sternum along the upper edge of the rib, then unite the lower ribs and nerves, and the lower edges of the ribs. In the place of the pleural emptying, you can drain with an extraordinary syringe, Janet's syringe or with special special apparatus. The syringe should be dislodged from the tube (trocar) inserted into the pleural empty space, behind the tap of the hum tube. When you pull up or out of the pleural emptying in front of a syringe, put a spout on the tube or close the tap, allowing you to get caught in the pleural empty space. In the world, the pleural space is removed from one side to the other. The evacuation of a great number of people is guilty because of the pleural emptying, it is guilty, so that you do not have to suffer a shy mediocrity. Try Ridini for laboratory dosage Collect in sterile test tubes, and in the same place - in a world flask. Opening in the shkіrі pislya P. p. Seal the deck with the rіdinoyu Novikov.
When carrying out P. of the item Mozhlivi accelerated: puncture of the leg, diaphragms, liver, spleen, shlunka (Fig.), Intrapleural bleeding, abdominal embolism of the brain. When the lung is punctured, there is a cough, and when it is introduced into the tissue of the lung lykarsky zasobiv see the gusto at the roti. In case of intrapleural bleeding for an hour, P. p. The red blood enters the syringe, and in the presence of a bronchopleural fistula, hemoptysis. The embolism of the brain can be manifested by a state of death for one or an insult to the eye, in more important cases - by the second testimony, by sudom (div. embolism ). If the heads get into the slurry through the diaphragm in the syringe, there may be a breakdown and slurry vmist. With all the delayed hours, P. p. It is necessary to phase the head from the pleural emptying, to lay the sick person on the back in a horizontal position, to wake up the surgeon, and in case of an onset of embolism to the brain, a neuropathologist and reanimation doctor.
Prophylaxis of acceleration, including the implementation of the punctuation and right of the head, the suvorentriad of methods and techniques of manipulation.
pleural puncture (Late late Pleuralis is carried to pleurisy; Latin Punctio injection; puncture; syn.: Pleurocentesis, thoracocentesis) - puncture of the thoracic and partial pleurisy, empty, or a trocar with the diagnosis of P. (diagnostics) P. p.). Viroblyayut ch. Pleural punctus. arr. with exudative pleurisy, hydrothorax, hemothorax, chilothorax, pneumothorax. Diagnostic punctuation allows you to clarify the appearance in pleural emptying exudate, transudate, blood, chilus, povitrya, її vmist for bacteriol., Cytol., Fiz. -khimia. doslіdzhennya. By the heads of the lykuvalnoy P. p. Є the vision of pleural space, the production of pleural emptying and the introduction in some of the new lykarsky preparations. Often the diagnosis of the punctuation is combined with the drug. Punctual viconuє lykar. In extreme cases (for example, in valve traumatic pneumothorax), a paramedic may be available. Call me a punctuation in the position of a sick person sitting. When buying a line in the pleural empty, the head and tulub of the ill guilty, but the hand on the side of the puncture is brought up the hill and forward, so that the broadening of the mid-ribs is extended and the puncture is carried out. The head and hand of the ailing one needs to be trimmed or victorious for the whole to cover the back of the style or a high style. In case of great cicatricial changes in the pleura, the puncture should be safely carried out in the position of a sick person lying on a healthy botsi; The head end of the operative or dressing table is slightly lowered into the whole vipad. Such a camp allows me to become ill with an embolism in the brain in the event of a wound in the lung and getting into it. The pleural puncture is vibrated in aseptic drains, which, as a rule, are administered with 0.5% novokain solution (10-15 ml). For a visual appearance from the pleural empty space, the puncture will start to shrink in this eighth intercostal space, between the middle groin and the scapula with lines, for the removal of the wound - in the other, or the third, middle ribs, along the middle clavicular. I will check the puncture for additional percussion, auscultation, fluoroscopy. Puncture on the upper edge of the rib, to eliminate the injury of the intercostal vasculature and nerve. In the place of the pleural emptyings, they are drained with an extravagant syringe, Janet's syringe, or with special vidmoctuval devices (div. Vidsmoktuvachi). Disconnect the syringe with a gum (or a trocar) behind the tap of a gum (plastic) tube. Before Tim, as you wiimati the syringe from the head, you need to close the tap or put the plug on the gum tube with the mark of stopping to drink in the pleural empty space. Samples for laboratory follow-up are taken in sterile test tubes, and the sample is taken in a glass flask. Opening in the shkіrі pislya P. p. Seal the deck with the rіdinoyu Novikov. When P. is carried out, the item Mozhlivi is accelerated - injury to the lung, diaphragms and lay down to some organs black empty... When you doze on such a wounded golk, it is innocuous to turn up, for ailment you get honey. caution; To the not uncomfortable acceleration of the embolism of the brain (div. Embolism). Prophylaxis of acceleration of the field in strict accordance with the methodology and technique of punctuation. M. I. Perelman.
Topic: Differential diagnosis of vipot in the pleural empty space.
Vipit in the pleural empty space is usually diagnosed in about 1 million people.
sick. Alle, I'll check the frequency of pleural vipotes.
pathological processes in the pleura may be of a secondary nature. Uninvolved on
the secondary nature of the accumulation of birth in the pleural empty space, often
the severity of overcoming the main ailment begins, and in the ranks of the
special drug visits. Differential diagnostics will be based on
principle: from the establishment of the fact that pleural vipot is evident through yogo
characteristics (transudate abo eksudat) before the etiology of the vipot is revealed.
Such a decision is to prevent the possibility of early detection of a disease and
early yogo lіkuvannya.
Normal and pathological physiology.
In normi mіzh with sheets of parietal and visceral pleurisy є 1-2 ml
ridini, which permits the visceral pleura of kovzati udovzh parietal pid
an hour of spirited rukhiv. Besides, there is such a small number of rіdini
zd_ysnyuє strength of the heat of the two surfaces. In normi in parietal pleura
there are more lymphatic vessels, in visceral - more blood-bearing ones. Diameter
blood capillaries in the visceral pleura larger than the diameter of the capillaries
parietal pleurisy. Rukh ridini in the parietal pleura
In accordance with the law of transcapillary exchange of Starling. The essence of the law
polyagaє in the fact that the collapse of the child's life is due to the difference
absolute gradient of hydrostatic and oncotic vice. V
According to the law in the norm of pleural origin from parietal
pleurisy go to the pleural empty space, the sounds are adsorbed visceral
pleurora. To get involved, in the parietal pleura, 100 ml of birth in
one year old, get wet with 300 ml, then in the pleural empty
practical nі. Інші ways of oversubstantiation of rіdini: vivedennya rіdini z
the pleural empty space can be seen on the lymphatic vessels of the parietal
pleurisy. In healthy individuals, drainage through lymphatic vessels becomes
20 ml / year, tobto 500 ml for dobu.
Mechanisms of accumulation of birth in the pleural empty space with pleurisy.
1. Increase the penetration of the parietal pleurisy,
moving the capillary hydrostatic vise in the visceral and
parietal pleura.
2. Increased amount of blood in the pleural empty space,
3. Reducing the oncotic grip of blood plasma.
4. Decrease of the intra-pleural vise (with atelectasis,
bronchogenic lung cancer, sarcoidosis).
5. Loss of pleural origin in lymphatic vessels.
In case of carcinomatous pleurisy, it is possible to add decile mechanisms.
Diagnostic jolt during differential diagnostics, including onset 3
1. The first stage is the establishment of the fact of the appearance of the line in the pleural
2. Reinstating the nature of pleural vipot - transudate chi
exudat. If the transudate tse is necessary, then it is necessary to get rid of it and
todі transudate rozmoktuєatsya. Yaksho vi set up scho tse eksudat
(Exercise pleurisy), then it is necessary to establish the reason for the manifestation of the exudate.
3. Vstanovleniya cause eksudat.
The plan for the treatment of a sick person with a vipot in the pleural empty space:
1. Clinical conditions: scarg, anamnesis, physical data.
2. Radiological details: chest radiography,
tomography of the breast cancer, bronchography, CT.
3. Thoracocentesis - pleural puncture.
4. Preceding the pleural birth: the name of the viglyad, the appearance of the bottle,
level of lactate dehydrogenase, level of glucose, amylase.
5. Cytological dosage of pleural vipot.
6.Invasive methods of pretreatment - display of pleural biopsy,
scan of the lungs, angiography of sudin legends.
7. In case of bagging pleurisy, the value of ultrasound is greater.
Skargi ill:
On pains in the chest
parietal pleurisy, and most often with exudative pleurisy)
Dry, unproductive cough. Vvazhaєte, scho accumulated rіdini
to reduce bronchial tubes, slow down and naturally to tease, then
є before coughing. A dry cough can be a manifestation of a basic illness.
· Zadishka - the main symptom of vipot in the pleural empty space. accumulation
birth in the pleural empty space until the change in VC and development of the
disadvantages, the main manifestation of which is zadishka.
Zagalny look:
Signs of the defeat of the other organs and systems: chi nemaє: peripheral
embankment, pechinkovy signs, improvement of thyroid glands, reduction of slopes,
improvement of lymphatic universities, growth of hearts, improvement
spleen, ascites and in.
Defeat in the system: beastly looking around the breast -
smoothed ribs, removed half of the cottage
mіstsyah shortening the percussion sound. Just a little bit of birth in the pleural
the empty space is small, then you can not cut off the shortening of the percussion sound. treba
Change the position of the sick person and re-clean it again.
X-ray signs:
· If ridini is not bagato (up to 1000 ml), then you can not poke anything.
You can pacify the purchased ridini in the sinuses.
If rіdini is more than 1000 ml, then it appears homogeneous darkening in
pleural emptying, with mowing upper rim. So buvaє do not expect.
Diffuse widening of ridini
Contralateral substitution of organs of the middle
Naybіlsh important for diagnostics є free vipit. it is necessary here
uvagu animals (especially in case of basal pleurisy) to be seen
the lower border of the lung and a twisted michur (in the norm, not more than 2 cm, with
the accumulated births of yak can grow). with interlobar
pleurisy chi vipotah - this is a double-convex tin, with cich stans
required common knowledge.
If you appear in the pleural emptying, then you pretend to be horizontal
rіven rіdini. Diagnostics is more important, if you remember all
pleural emptying. The darkening of all empty buva: with total
pneumonia, obliteration of half of the breast emptying, with atelectasis for some reason
newfoundness. If you are in one half of the breast, then the
to vindicate contralaterally, and as atelectasis, then to organize vindication in
side of the battle.
In case of total pneumonia, there is no general darkening, it is absolutely necessary
viconati signs in dynamism.
If they didn’t help it, then it’s necessary to go to CT scan.
encapsulated pleurisy dopomagaє UZD.
If the fact of the appearance of a line has been established, then go to the offensive stage -
the stage of establishing the nature of the pleural birth, for which it is carried out
pleural puncture.
Algorithm for differential diagnosis of transudate and exudate:
As soon as transudates are established, it is not important to show the reasons:
1. Stagnant heart failure
2. Nephrotic syndrome: glomerulonephritis,
3. Liver cirrhosis
4. Myxedema
5. Embolism legendary artery, For the form of infarction-pneumonia and vipot
6. Sarcoidosis
It is necessary to get rid of the main disease.
As the rulings of the exudates, the ethology of the exudates is more profitable.
1. Perche mice - new solution: metastatic lesion of pleurisy,
the primary pleural effusion is the mesothelioma.
Anaerobic flora
Tuberculosis (20-50%)
Bacterial
· Pneumococcus. In parallel with pneumonia can develop
parapneumonic (developing at once from pneumonia) and metapneumonic
(Pislya pneumonia) pleurisy.
· Stafіlokok. In the main є cause of pleurisy.
Microplasm
Friedlander's Wand
Sinogniina stick, kishkova palichka
Fungi
Aspergilosis
Candidiasis
Blastomycosis
3. Embolism of the legendary artery
4. Infection of the slunk-intestinal tract: state and chronic pancreatitis, pukhlini
perforation of the intestinal tract, subphrenic abscesses, perforation
5. Systemic discomfort with the resulting tissue: VKV, rheumatoid arthritis.
6. Systemic vasculature: higher education
7. Allergic illness: postinfarction allergic syndrome,
lykarska allergya
8.Inshi sickness of that country: asbestosis, sarcoidosis, uremia, exchange
therapy, chylothorax, hemothorax, electroopic and in.
The third stage is the establishment of the etiology of pleurisy.
Warehouse of normal pleural origin:
Normal warehouse of pleural origin.
Pitoma Vaga 1015
Kolir - straw'yano-zhovty
Transparency is a povna
non-viscous
Doesn't smell
Klіtinniy warehouse:
back number of erythrocytes 2000-5000 in mm 3
back number of leukocytes 800-900 mm 3
neutrophils up to 10%
eosinophils up to 1%
basophils up to 1%
lymphocytes up to 23%
endothelium up to 1%
plasmatic up to 5%
block 1.5 - 2 g per 100 ml (15-25 g / l).
LDH 1.4 - 1.7 mmol / l
glucose 20-40 mg per 100 ml (2.1 - 2.2 mmol / l)
estimation algorithm the most recent viglyad pleural birth:
As soon as the blood is born, then there is a general requirement for hematocrit -
If the hematocrit is more than 1% - then you need to think about swelling, injuries,
Embolism of the Legendary Artery.
· At 50%, there is a clear hemothorax, which is a vimag of a secret drainage.
Transparency
Povna discernment - then the need to proceed to the biochemical
doslіdzhennyu - rіven glucose and amіlazi:
If the level of glucose decreases, then the most important reason
є badly approved for tuberculosis.
If the level of amylazi is advancing - the sooner the pathology of the pidshlunkovoi
zolozi abo zhvoryuvannya stravohodu (cancer).
If the level of amylase and glucose is normal, then go to
cytological dosage of pleural origin.
Kalamutna - chylothorax or pseudochilothorax - treba doslidzhuvati lipidi
Yaksho viyavili crystals of cholesterol - pseudochilothorax
Yaksho viyavili crystals of triglitserides - chylothorax, which is
the lot of the head lymph nobles with the chubby
Cytological dosage:
In case of squamous cancer - a positive result is seen rarely
Positively in most cases with lymphomas - 75%, especially with
hypocytic lymphomas, 20% - lymphogranulomatosis.
Viznachennya klinny warehouse:
Reveal of leukocytes - gostry pleurisy, with pneumonia -
parapneumonic pleurisy. Iaksho dumb pneumonia - that is the need for Viconati CT,
thoracoscopy, lung scan, pleural biopsy.
· The overhaul of mononuclear cells is a trivial accumulation of money.
The given poke - tse obov'yazkovo biopsy pleurisy (dvorazova) - with meta
viznachennya malicious approval for tuberculosis. Diagnosis is not
decisions of the double-sided double-sided pleurisy biopsy, then it is
before CT, scan of the lungs, in case of general symptoms of angiography. at
scanned legend can be found in embolism.
Characteristics of transudate with congestive heart failure.
Transudates are often seen with congestive heart failure: skargi
ailing, signs of lack of blood circulation. roentgenologic:
double-sided accumulation of the same obsyagu rіdini in both empty spaces. at
unilateral accumulation, or non-similar piles - obov'yazkovo zrobiti
pleural puncture, which can be caused by pleurisy. diagnosis
lack of heart failure is not a diagnosis cancer of the legacy.
As soon as the transudate is located in the pleural discharges, then the number of
bіlka in nіy can, grow up to this, like with exudative vipots!
Characteristics of transudate in liver cirroses. With cirroses, ridin in
Pleural emptying often occurs with ascites. On vidminu vid vipot when
long-term heart failure vipit can be one or two-sided.
Mechanism of establishing pleural vipot in liver cirrhosis:
1. Reducing the oncotic grip of blood plasma.
2. Naybilsh vіrogіdne - drinking ascitic rіdinі s cherevnoї
empty in the chest on lymphatic vessels, or through defects in the diaphragm. at
strained ascites to move the internal vise, diaphragm
stretch, and stretch diaphragms to produce microdefects,
through yakі rіdina and smack in the chest empty.
Diagnostics is folding: it is necessary to carry out thoracocentesis and laparocentesis
overnight. At the same time in this day there will be a low vmist
bіlka, low level of LDH. Ridina in the pleural empty space with ascites can
buty bloody, tied to the wreckage of the main bureaucrats
zgortannya, inaslіdok urazhennya pechіnki.
Characteristics of the most frequently occurring exudates:
Exudat for new establishments:
Causes of metastasis:
Most often metastasis peripheral cancer of the leg, cancer
milky zalozi, lymphomi. Pervinna puhlina does not rise in 14%.
Mechanism of establishing pleural vipot in case of malignant new solutions.
Direct inlet of chubby:
1. Metastasis of swelling in the pleura
and obstruction of lymphatic vascular disease).
2.reduction of lymph nodes in the middle (reduction of lymph nodes in the middle
3. Blockage of the thoracic duct (with partial development of chylothorax).
4. Obstruction of the bronchus (decrease vnutrishnopleuralno vise).
5. Striking the pericardium.
Periodicals in the injection
6.hypoproteinemia due to metastatic liver disease
7.Embolia Sudin
Warehouse of pleural origin in case of evil new solutions:
· Zbіlshennya erythrocytes in 50%, the number of perevischuє 100 yew.
Eosinophilia is not characteristic
Rіvko decrease rіvn glucose - below 60 mg per 100 ml rіdini
It is possible to grow amylazi in case of primordial puffiness
pidshlunkovoy zalozi.
In diagnostics, additional help in cytology has been completed. at
metastatic puffins, metastases are localized in the visceral pleura, and on
biopsies take parietal pleura.
CT scan, bronchoscopy, bronchography are performed twice
pleural biopsy.
Primary lesion of pleurisy is spontaneous with mesothelium. mesothelioma
It develops more often in particular, when there is contact with asbestos. Period between contact i
The winners of the pukhlin become 20-40 years. The chubby can move from
children, daddy and mali contact with asbestos.
Look good and bad mesotheliomy. evil
mesothelioma is immediately hostile to the pleura, pericardium, liver, often
snakes in legends. In general, people are sick from 40 to 70 years. first skargo
є zadishka, attack a cough, rarely - pain in the chest. most
Significance of ma radiography: great (often total) vipoti in
pleural emptying, in 50% of the area of blood, with a sharp decrease in the level
glucose. Ridina knitting, viscous, for the great rakhunok in the place of hyaluronic
acid. The best method of diagnosis is pleural biopsy and CT scan. great
meaning of cytological dosage of ridini - evil
mesothelium cells, the number of which is 5-15%. forecast
unwelcoming, ailments go after 7-10 months when you appear
pleural vipot. If the disease is diagnosed in the first 2 stages, then
chemotherapeutic dosage of life and quality of life.
Good mesothelioma - pukhlina is stored with a good fabric, ale
yes vipoti, often hemorrhagic. Likuvannya - hirurgichne, forecast
friendly.
Exudate with parapneumonic pleurisy. Naybilsh often cause
parapneumonic pleurisy є anaerobic flora, older pneumococci і
gram-negative flora. With parapneumonic exudates, pleurisy
maє 3 stages:
Stage 1 - the stage of sterile birth
Stage 2 - fibrinous-gniyna
3 stages - the stage of organizing vipot with the statements of pleural nasruvans
(Mortise), as I can more obliterate the pleural empty space and the lung
ceases to function.
Parapneumonic pleurisy vimagayut the rational sign of antibiotics. V
In addition, the pace is developing.
Signs of the transition to pleural tempo:
1. Ridina grows kalamutny with a rotten smell.
2. The pitoma of the vagina of the pleural origin is moving.
3. With microscopy, there are some blood cells and leukocytes.
4. In case of seeding pleural origin - growth of bacteria.
5. Fix the decrease in glucose level, if the amount is lower than 60 mg per 100 ml,
Then the process is clearly going to the pace.
6. The pH of rіdini goes down.
7. Risko rіven LDH rіven (over 1000 od.).
Tuberculous pleurisy.
If the reason is not established, then there is no need to carry out therapy ex juvantibus, but
It is better to immediately conduct a thoracoscopy and a pleural biopsy and establish a diagnosis.
Pleurisy with pancreatitis. It is recorded in 17-20% of vapors. accumulation of money
by virtue of 3 mechanisms:
1. Transudation through the diaphragm, if the igniter exudate is
uzhenoї pidshlunkovoy zalozi penetrates through the diaphragm.
2. On the lymph paths.
3. Osvita of fistulas between the slurry zone and pleural
empty - most often.
Often pleurisy occurs in chronic pancreatitis.
A clever picture lies in the nature of the process: in case of a state of pancreatitis
to feel pain in the breast tissue, backwardness, on radiographs - not great
a bit of birth in half of the breast cell, how to appear at the viglyad
opacity (midness) and inertia of the dome with diaphragms during the її Rusі. at
chronic pancreatitis is more likely to have symptoms of the side of the breast
(Pancreatopleural fistulas form more often)
great number - great total pleurisy. at last
pleural origin is determined by changes in amylazi - ponad 100 yew.
od., velikiy vmist bilka, LDH, increase of leukocyte counts up to 50
At the tsіy statty mi it is clear, as well as pleural puncture, as before it is shown, the technique of carrying out and the video, as it is, is shown.
Pleural puncture: visualization, showing
Pleural puncture is a puncture of pleural emptying, that is, emptying, rosted and visceral and parietal pleural leaves.
Run into the pleural empty space to accumulate ridin when dear ones- with swelling of the leg or pleurisy, with pleurisy, with tuberculosis, with heart swelling, etc.
The main indications to pleural puncture serve as a manifestation in a new age, as it can be seen with ultrasound of the pleural emptying, or with X-ray. It is also possible to increase the amount of time in case of percussion of pleural emptying.
Shown up to puncture of pleural emptying є also: pleurisy, intrapleural bleeding, pleural tempo, transudate in the pleural emptying during blockages.
Diagnostic pleural puncture should be performed in the dressing room, and for important ailments - in the ward.
Technique of carrying out pleural puncture
For making a victorious leg with a length of 9-10 cm, a diameter of 2.0 mm, we can steeply beveled (up to 60 °) to the edge. For the help of an adapter - a gum tube, drain the golk from 20 grams with a syringe. Releasing the syringe in the world, we remove it from the pleural emptying space and periodically rewind it with the instrument. Tsey priyom is necessary for the penetration of her poop. To deliver with a hand the yak of the adapter є vikoristannya specially prepared two-way faucet.
The pleural emptying is punctured in the position of the ailing seated patient with the introduction to the side and the spaced out on the support with the hand. At such a position, the posterior costal-diaphragmatic sinus is occupied by the lower sides of the pleural empty space.
A puncture of the chest wall is visible in the VII-VIII mid-ribs along the posterior groin, or the scapula lines. At the time of exudation of the exudate, the introduction of the head into the pleural empty space begins, based on the results of radiological abo ultrasound dosage.
Otzhe, coating technology pleural puncture:
1) Collected in a syringe novokain 0.5%. Naykrashche take a 2-gram syringe. I collect this new message.
Remember: less than the area of the syringe plunger, less painful pleural puncture. It is especially important to be quiet if you are experiencing pleural puncture in children.2) It is possible to prescribe a new message at once, it is possible to prescribe a new word, by and by pushing on the syringe plunger, and also by pushing on the piston of the syringe. m'yak_ fabric chest wall.
Remember: punctuate the head to enter in the intended intermediate on the upper edge of the rib ... As soon as the head is inserted along the lower edge, then it is possible to insert the intercostal artery, and even not without a glance at the unstoppable bleeding from it (Fig. 2)3) The visible spring support of fabrics, rosted in the area of the intrathoracic fascia. And at the moment of penetration of the head into the pleural empty space, there is a view of the "great space".
4) With a turn of the piston into the syringe, it is necessary to knock out instead of the pleural empty space: shelter, gn_y, sickly type of exudate. Tsia persha is a visual assessment of the result of pleural puncture, an important one in diagnostics.
5) A small thin head from a disposable syringe, which robbed the sickness, for more, bagatorazu, came to it through an adapter, a hose from an elektrovidmoktuvach and I know it chest wall on the already anesthetized m_stsya. І vidkachuєmo exudate from the pleural emptying for the additional release.
As a rule, the diagnostic puncture should be transferred into a medical procedure, including more visibility of the pathological one, the treatment of pleural emptying with antiseptic drugs, the introduction of antibiotics, and the drainage of blood vessels for autologous diagnosis.
Small. 2. Diagnostic puncturing of the pleural emptying: a - the way of increasing the consumption of the emptying in the pleural emptying; b, c - topography of intercostal blood-bearing vessels. Shown without baking directly injected head at puncture
For rejection of more, often - detailed information about the port instead of the pleural emptying, they are guided by means of cytological, biochemical, bacteriological and biological vaccination.
And the video axis of the pleural puncture:
Puncture of the emptying of the pericardium. Diagnostic puncture of the pericardium should be performed in the dressing or operative area.
Have a sick person lying on the back in the cuff, made by the livi-ribbed arch and sword-like with adroit, Pozharovo іnfіltruuchi shkіru і pіdleglі textiles 2% with a range of trimecaine, fry the surface ball and straight abdomen.
Small. 3. Diagnostic punctuation of the emptying of the pericardium. Shown without baking directly injected head at puncture
When the body of the syringe is drawn, open it up to the collar and push through the head in a straight line to the shoulder joint ailing, zberigayuchi kut 45 ° to the horizontal area (Fig. 3).
With the penetration of the golki into the empty pericardium, the syringe will begin to fit into the syringe and the ejection will be enough.
The first part of the pathological one can be visually introduced and guided for cytological, biochemical, bacteriological pre-treatment. The diagnosis of punctuation is completed by the lykuvalnoy procedure - to remove the emptying of the pericardium, and to receive an antiseptic solution.
With a tsієyu mark, vikoristovuchi punctzіynu golku, vikonuyut drainage of the empty pericardium according to Seldinger. It’s necessary to look at those who, in the world of emptying the pouch of the heart, come close to being close to the end of the head, which may be the reason for the injury of the scooper during the first speed.
In addition, a catheter in the empty pericardium, an overflow of a pericardium, can be used as a pericardium for repeated diagnostic and medical procedures.
Pleural puncture is most often a diagnostic punctuation. As a rule, there is accumulation of ridin in cases of inferior diseases, for example, with swelling of the leg, with heart swellings, with tuberculosis or pleurisy. A whole fact є submitted for the pleural puncture. The level of emptying starts at percussion, during radiography, or at ultrasound pre-detection of pleural emptying. Empієma, intra-pleural bleeding and transudate in the pleural empty space are also directly indicated for the procedure.
Pleural puncture. technique of carrying out
Diagnostic pleural puncture is carried out in the dressing or in the patient's ward. The patient should be carried out with a new one, for an hour of the procedure, the patient will be seated in a sitting position with his hands brought back. Whether a diagnostic punctuation is most often completed with trips, and the most visible pathological ones instead of empty, treated with an antiseptic and introduced into the empty antibacterial drugs... In case of hemothorax, drainage is carried out with a system for the preparation of autologous blood. The first porting together from the pleural emptying is evaluated visually by the doctor, for the purpose of removing more detailed information, instead of going to cytological, biochemical and bacteriological information.
Pleural puncture. may you expedite
Carrying out the procedure for the promotion of special tips at the doctor, and this is not the least of the way with a competent approach at the patient in the process of manipulation, there may be a possibility of accelerated development. Tse can be used for the reduction of the middle, tachycardia, collapse. If the patient is uniqueness of such manifestations, the car is guilty of retreating behind the patient's camp and after an hour of pleural puncture to squeeze the tube with a grip.
How can a pleural puncture be performed?
At the pleural empty space great people it should be approximately 50 ml of age. The poisoning of the legends and pleurisy can lead to the point where the leaves of the pleura accumulate to accumulate or ignite the ridina. Oskilki won the patient's stance, I see it with pleural puncture. Iakshcho rіdini is not a good idea, it means that the pa- tients are trying to correct the diagnostics punctuation, the additional help is given to the appearance of pathological clines and the character of accumulated rіdini.
Preparation for pleural puncture
The set for pleural puncture includes a twenty-gram syringe, a head of 7-10 cm with a length of 1 - 1.2 mm in diameter, and with a sharp beveled edge, you must come to the syringe with a humid tube. After an hour of procedure in the pleural empty space, without eating too much, a special trick will be imposed on it. A set of two - three test tubes is required for sending the expulsion to a prescription, but a sterile tray with tweezers, tampons, cotton swabs, as well as alcohol, iodine, and food for a non-alcoholic standard is required.
Pleural puncture with pneumothorax
Spontaneous pneumothorax is also a direct indication for pleural puncture. The technique of carrying out the process of manipulation is not at all attributed to the sinister, for the blame of the fact that in case of pneumothorax with pleural puncture with a syringe, or the pleuroaspirators are dislodged. During the development of the povitrya for an hour, the inhalation is constantly coming into the pleural empty space. Oskіlki zvorotny drainage in the daytime, the pipe is not charged with punctuation, but it doesn’t add drains. Do not forget to forget, when the pleural puncture of the patient goes through the term of the hospital in the surgery.
In the medical field, the most frequent puncture of the pleural emptying. Won’t get stuck for analysis together, but you’re allowed to stand correct diagnosisі carry out effective treatment.
Pleural puncture є a procedure, when a puncture of the sternum is introduced, as well as pleurisy. The operation is indicated for ailments, which are supervised by the purchased food, anyway. It’s not possible to carry out such manipulations quickly, it’s easy to get well, but the patient sees difficult times when he is crazy.
Puncture is indicated in case of exudative pleurisy, tuberculosis and other illnesses.
Dial for punctuation
In order to carry out a pleural puncture, a set of instruments is required. Do not enter the next step:
- punctuation of the head;
- 50 ml syringe;
- the tube is complete;
- drainage mn_st.
preparation of the sick
Oscillations of punctuation in a deyako sense is similar to an operation, as if it were internal involvement, there is a fear of patients. Such a rank, zavdannya medical workers polyagaє in the fact that you are sick. The main reason is to pay the nurse. The patient needs to clarify the need for the procedure, as well as to learn in detail about the technical details.
If psychological assistance will be given, preparation will be needed before anesthesia. Specialist is guilty to look around the sick person, to introduce lіkuvalny drugs, I will help you to learn about anesthesia and to overcome the possibility of showing allergic reactions to anesthesia. In such a way, they make tranquilizators, snodiyne and іnshe. In addition, the pulse is shown to the patient, arterial vise.
Preparation before the procedure
The nurse is guilty of being present during the operation, so that the doctor will help you. A handful of nurses ready to dial for the punctuation. Everything is guilty but sterile: gloves, tools, steel. Before the visitation of the procedure, the lycar was viscously doused with antiseptic preparations. The patient will be delivered to the procedural room and will be provided with a glass. The hand is on the side, from which a puncture will be carried out, bend and wind up behind the back. It is necessary to expand the space between them.
Innocent patient is on a vaschke, but he is not able to show the procedure of sitting. Such a vipadku won’t be seen when lying down.
vikonannya punktsii
Persh for everything, to get rid of the puncture. Iodine roschin, "Chlorhexidine" Sickness was held for the help of Novokaina. Then you can dial up for the punctuation, take a thin head. Vaughn z'єєnutsya zі syringe for an auxiliary gum tube. The tube will be secured, with a tube equipped with a tube.
Technique of carrying out pleural puncture to lay down in order. If it is necessary to see the puncture, the puncture is inserted between the other and the third rib. If it is necessary to get rid of the foreign country, the goal should be introduced into the eighth-eighth mid-region. In order to remove the nerves from the end and not to fasten the puncture, the puncture should be placed along the upper edge of the rib. When the goals are introduced over other ridges, there is a sense of the eye, the reason for the fact that the age of birth will appear. With such a rank, the necessary result will not be achieved. As the head is set back low, it is possible to display the internal organisms in a vague way.
Otzhe, vikoristovuchi special tools, how to enter the recruitment, from the pleural emptying is seen again or again. If the syringe gets clogged with blood houses, the operation is pulled back. The cough of a sick person can serve as a guide for a zupinka vivedennya. Yakshcho parkan ridini all the same, you can sit in dry dishes, yaka is bound to be sterile. The shkira in the puncture will be clenched with your fingers, the head will climb to the side, and the dilenk will be covered with alcohol, like a tampon.
As soon as the pleural empty space is stored by the turn of the day, the importance of its manifestation is also possible. To puncture the puncture to the tube, press the pressure gauge. At normі the grip in the pleural emptying is negative. If the pressure gauge shows a positive result, it means that you will be in your presence.
accelerating
If the procedure is completed, the set of tools should be put aside for further disposal. In some cases, there is an acceleration in the viglyad, the middle, tachycardia, a puncture of the internal organ.
A patient can take in some witness, in some cases he can do something about it, he needs to constantly help him out of his camp, so I can help you out of it.
Pleural puncture is an important diagnostic method. Vaughn let the ailment come on early stage, Mean likuvannya, do not give the opportunity to go to the important form. In order to minimize the amount of time, for the punishment, the vicarists are guilty of a set of sterile instruments. There is a great role in the success of this manipulation of the drug qualification.
Pleural puncture (thoracocentesis) is borrowed in the interim between conservative and operative licenses. This procedure is based on a puncture of a bare chest wall with diagnostic and medical treatment.
Our legends are covered with a serous membrane - visceral pleurora. Qia obolonka go to internal surface breast tissue and parietal pleura. Between two leaves є empty, filled with a small number of ridini. Itself in the whole space of the car to carry out the goal.
What if pleural puncture is performed?
Pleural puncture in pulmonology is often observed. Pleural puncture, evidence:
- Hydrothorax is the most frequently indicated for the procedure. Tsei stan means the purchase of rіdini in the pleural emptying. Vono can be wicked by the very pathological processes. The causes of hydrothorax are swelling, liver cirrhosis, chronic heart failure, nephrotic syndrome in cases of nirok and so far.
- Tuberculosis is a chronic inflammation process, mycobacterium wickedness, possibly the cause of exudate in the pleural emptying. It can be seen in case of an extended infectious process or subpleural localization of the primordial head.
- Pleurisy is an inflamed serous membrane with an exudate. Vin man fiery character and revenge immune cells organism. Vinikak is fond of trauma or penetration of microbes. Pleurisy is autoimmune in nature.
- Intrapleural bleeding is a diagnosis of chest trauma or lesions. Characterized by inflamed pleurisy with blood.
- Empiєma pleurisy is an important ignition process. In case of a pathology, the entire pleural beetle can be filled with pus. At the same time, the country’s camp and demand for more love is still awful.
Shown to the pleural puncture to be supplemented with a camp, if in the pleural emptying there is no home. In general, the procedure is to wear a diagnostic meta. As well as being ill, it’s a likar to carry out the manipulation with the employees - a vision of the pathological birth.
Prototype
Punctuation of the pleural emptying is shown, only when it is turned on. Prototypes can be shown:
- Lack of visualization - for carrying out pleural puncture, it is recommended to use ultrasound and X-ray diagnostics of the pathological process.
- Minimalny obsyag rіdini. In case of unimportant pathological processes in the pleural emptying, a small amount of exudate accumulates, which cannot be punctured.
- Anatomical defects of the breast cancer. Increased anomalies may speed up the procedure.
- The important zagalny camp of the patient. in case of a disagreement non-slip mills it is necessary to have a chance to compensate for the sickness, and then to carry out the procedure.
- Hemorrhagic diseases and defects of the laryngeal system. There is a wide range of contraindications, however, the manifestation of such a problem can be the cause of an important delay in the appearance of massive bleeding.
- Uncontrollable cough. Kashlyovi ruku before the hour of the punctuation can bring up to the point of a lung, so before the procedure it is necessary to try to get rid of this symptom.
Pererakhovanі contraindication vyklyuchayutsya lіklyuchayutsya in the course of preparation before the manіpulation.
come in
Preparation to pleural puncture is monitored with a drug. It is not necessary to see a special patient before the procedure.
The training complex includes the following:
- Prepare instruments for pleural puncture to be a medical nurse. For the procedure, a special pleural puncture head is also selected.
- Diagnostics of the pathological process behind additional radiography of the thoracic cell or ultrasound diagnosis of pleurisy. With these procedures, there is an intervipot in the pleura.
- Preparatory work for the patient of the polyagus at the vicious cough rukhiv. For the whole, protikashlyov_ preparations are used. Sickness is evident before the procedure.
Puncture of the pleural space is taken to the dressing room or to the procedural room. If the patient's transportation is uncomfortable, the procedure can be carried out directly in the ward.
go procedure
Conducting pleural puncture - ligation of the doctor. Її do not conduct medical sisters for paramedics. Algorithm for the offensive:
- A head with a great dozhina and a diameter of two millimeters should be closed with a syringe behind an additional adapter. The switch will be tamped with the tool if necessary, remember the syringe during the evacuation of the day.
- The patient is in the seated position. Punctuate the hand from the side to the side.
- The misplaced puncture will start to grow in the eighth mid-groove along the back groin line. With individual specialties, the point can change.
- The technique of the procedure is to be repaired from the smell. The syringe is filled with anesthetic novokain. The puncture is punctured and the lines are presupposed in the course of the puncture.
- Likar will punish breast tissue along the upper edge of the lower rib. This technology allows you to preserve the integrity of the judgment and nerves.
- After penetrating into the empty pleura, the car would see a failure. With the help of a general medicine, the evacuation of the pathological birth was started. To take away is not a large number.
- Dalí lykar viroblyaє I will repeat the item already great, prepared in advance. Through the adapter it is possible to connect the electrical power and the entire export from empty.
After the procedure is carried out, a bandage is applied to the breast tissue, and the patient will remove antibiotics with prophylactic treatment.
accelerating
In the course of the manipulation, it is possible to get a quick check, most of them are prevented by secondary training.
The reason for the unwelcoming inheritance can be:
- Lack of quality tools, for example, goals.
- An important zagalny camp of a patient, a fellow patient.
- Cough abo rіzki rukha ailing before an hour of procedure.
- Pardons on the side of the medical staff.
- Lack of diagnostics of the pathological process.
May be expedited:
- Parenchymal injury to the organ. It can be easier to get naked, with a lot of damage it gets into the pleural empty space and pneumothorax develops. Tsei stan vimagak dodatkovogo lykuvannya.
- Injury of the vertebrae and nerves. When the puncture technique is broken, the drug can pierce the intercostal vertebral nerve bundle. Shelter waggle into the middle of the pleural empty space, hemothorax is vicious.
- Poshkozhennya diaphragms barely wounded organs of the black empty - nirkas, liver, intestinal loops. It is important to accelerate the cause of peritonitis and in the process of operative treatment.
- Collapse - in the course of manipulation, the patient can drastically reduce the arterial grip. The reason may be a reaction to the new, or the very pockening of the breast cancer.
- Infectious diseases accelerated. Puncture є introduction outside body into a sterile empty. They can develop ignition processes... The process of acceleration is prophylactic for sterile instruments and antibiotics.
Lykar know about may you expedite and to destroy everything, to remove the pathological stanіv.
