Some say position the infant with a rolled up towel to 60-75 degrees off bed to evacuate air, and 15-30 degrees for fluid, chyle, blood, or pus.Įmergency needle aspiration (tension pneumothorax). The most common position is supine, with the arm at a 90-degree angle on the affected side. Position the patient so the site of insertion is accessible.
PLEUR EVAC DRAINAGE AT HOME SKIN
Weak light source, bright room lights, small pneumothorax, thick chest wall with edema, thick skin folds on a large baby, and dark pigmented skin. Subcutaneous air, severe pulmonary interstitial emphysema, lobar emphysema, pneumomediastinum, large air bubble in the stomach, and too dim of a light source.įalse-negative transillumination. See Figure 11–20 for a radiograph showing a left tension pneumothorax.įalse-positive transillumination. If air is suspected, the infant should be lying on his or her side with the suspect side up if fluid is suspected, the infant should be placed with the suspect side down. A lateral decubitus or cross-table lateral x-ray film should be done. Unless the infant's status is rapidly deteriorating, a chest radiograph should be obtained to confirm pneumothorax before the chest tube is inserted. The affected side usually appears hyperlucent (“lights up”) and radiates across the chest as compared with the unaffected side. With the room lights turned down, a strong light source is placed on the anterior chest wall above the nipple and in the axilla. Transillumination of the chest may help detect pneumothorax but not a small pneumothorax (see Chapter 40). For fluid collections, place the tube posteriorly and laterally. For air collections, place the tube anteriorly. Air collects in the uppermost areas of the chest, and fluid in the most dependent areas. The site of skin insertion for the elective chest tube insertion is the same for both air and fluid, but the direction of the tube is determined by examining the anteroposterior and cross-table lateral or lateral decubitus chest films for air or fluid. Pigtail catheter sizes range from 5F to 12F with 8 and 10F most commonly used. It may not drain a pneumothorax with an ongoing air leak. Disadvantages are that the catheter may kink and become obstructed since they are softer. This is an easier and less invasive technique requiring less anesthesia. The pigtail catheter is inserted through a needle. Percutaneous chest tube with pigtail catheter. Recommended size for weight: 8 or 10F 2000 g.
Use polyvinyl chloride (PVC) chest tubes 8, 10, or 12F.
Requires a skin incision with blunt chest wall dissection and sutures. Standard (traditional) chest tube insertion. Chest tube types and sizes are as follows: A high-intensity fiber optic light for transillumination is helpful (see Chapter 40). 11 or 15 scalpel, scissors, a needle holder, antiseptic solution, antibiotic ointment, 1% lidocaine, 3-mL syringe, 25-gauge needle) sterile gloves, mask, eye protection, hat, gown, suction-drainage system (eg, the Pleur-Evac system). Prepackaged chest tube tray (sterile towels, 4 × 4 gauze pads, 3–0 silk suture, curved hemostats, a no.
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