胸腔穿刺术(国外英文资料).docx

胸腔穿刺术(国外英文资料).docx

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胸腔穿刺术

Pleuralcavitypuncture（thoracentesis）,referredtoas"chestwear,referstopatientswithpleuraleffusion（orpneumothorax）,inordertotheneedsofthediagnosisandtreatmentofdiseasebypleuralpuncturepumpingafluidorgastechnology.

Catalog1thoraciccavitypunctureisthemainfunction

2indications

3contraindicated

Preoperativepreparationofa4

5steps

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Position?

Selectthepuncturepoint

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Operatingprocedures

6postoperativetreatment

7pointsforattention

Complicationsandprinciplesofmanagement

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pneumothorax

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Bleeding,bloodchest?

Diaphragmaticinjury,liverandotherabdominalvisceralesions

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Pleuralreaction

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Withinthechestinfection

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Complexpulmonaryedema

Safetyguidelinesforthoracicpuncture

10methodstoimprove

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Thoraciccavitypiercingnegativepressuredrainagedevice

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Theapplicationofthecasingneedleinthethoraciccavity

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Theapplicationofthedrainagetubeinthethoraciccavitypiercing

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Applicationofcentralvenouscatheter

Thoraciccavitypiercingisthemainfunction

Takepleuraleffusion

（1）generalcharacteristicsofmonitoringanddetectionofbacteriologyinspection,chemicalandmicroscope,clearthenatureoftheeffusion,lookingforacauseofeffusion;

Toremovetheaccumulationandaccumulationofthepleuralcavity,reducethepressureofthefluidandgasonthelungtissue,andmakethelungtissuecomplexandrelievethepatient'sbreathingdifficultiesandothersymptoms.

Anabscessfromtheparietalpleura,whichiswashedinthechestandtreatedabscess;

Thepleuralcavitygivesthedrugapleuralinjectionofantibioticsoranti-cancerdrugs.

2indications

Diagnostic:

（1）,pleuraleffusionofunknowncause,asadiagnosticbiopsy,pleuralfluidsmear,culture,cytologyandbiopsyinordertomakeclearthecause,andcancheckthelungs.

（2）treatment:

thesymptomsofalargeamountoffluid,compressedair,andbreathingdifficultiesinasingleorbilateralchest,throughpumping,pumping,orthoracicdecompression.Injectdrugsintothechest（anti-cancerdrugsorpromotepleuraladhesionsetc.）.

3contraindicated

（1）itisdifficulttotoleratethepunctureofapersonwhoisphysicallyweakandcriticallyill.

（2）.

（3）thebloodfunctionobstacle,severebleedingtendency,thepatientshouldnotbepuncturedbeforecorrecting.

（4）amentalillnessoraninauthorship.

（5）forpatientswiththoracicdisease,puncturecancausetheinfectiontospreadandnotpuncture.

（6）thereisaninfectioninornearthepuncturesite.

Preoperativepreparationofa4

（1）.Understandandfamiliarizeyourselfwiththepatient'scondition.

（2）.Talktothepatient'sfamily,explainthepurposeoftheexamination,thegeneralprocedure,thepossiblecomplications,etc.,andsignthename.

（3）.Equipmentpreparation:

pleuralpuncturebag,sterilechestdrainagetubeandthedrainagebottle,skindisinfectant,anesthetics,sterilecottonball,gloves,drapes,syringes,gauzeandtape.

5steps

（1）.Position

Thepatienttakestheseatinthebackchair,andtheforearmisplacedonthebackofthechair,andtheforeheadisontheforearm.Thepatientmaynotbeabletogetoutofbed.

（2）choosepuncturepoints

Themostvisiblepartofthethoraxofthethoraxwaschosen,andthethoraxlinewasusuallytakenbetweentheshoulderscapularorthe7thand8thriboftheposteriorlineoftheaxillaryline.Sometimesitisalsoselectedasthepuncturepointbetweenthe6thand7thribsoftheaxillarylineandthe5thribintheaxillaryline.ThewrappercanbedeterminedbyeitheranX-rayoranultrasound,andthepuncturepointsaremarkedontheskinwithaswaborothermarker.

（3）theoperationprocedure

Aroutinedisinfectantskin:

disinfectionatthecenterofpuncture,about15centimetersindiameter,twice.

Bopendisposablepleuralpuncturebag,wearsterilegloves,coversteriledrapes,checkwithinthepleuralpuncturebagitems,payattentiontothechestneedleandcheckwhetherunobstructedafterinfusionconnectionwithasyringe,andcheckforleakage.

Cassistanthelptocheckandopenthe2%lidocaineampoules,performerto5ml,2-3mlsyringe2%lidocaine,thepuncturebytheepidermistoparietalpleuratopicalanesthesia.Ifthepuncturepointisthescapularlineorthebacklineoftheaxillary,theuppermarginoftheribisinsertedintoananestheticneedle,suchasapuncturepointinthemidaxillarylineortheaxillaryline.

D.connectthebreastneedleandthepumpwiththesyringe,andclosetheswitchbetweenthetwotoensuretheclosureistight.Performerwithonehandindexfingerandmiddlefingerpuncturetheskin,theotheroneholdinganeedlealongtheanesthesiainslowlyPierce,whenneedlefrontresistancefeelingasuddenfeelingdisappear,turnontheswitchandchestareinterlinked,infusion.TheassistantUSESahemostaticforceps（orextrapliersinthechest）toassistinthefixationofthepunctureneedle,whichisusedtopenetratedeeplydamagedlungtissue.Aftertheexpirationofthesyringepump,closetheswitch（somewearchestbagsinfusionwithsyringefrontlivedforone-wayvalvedesign,cannotclosetheswitch,dependingonthespecificsituation）todischargeliquiddrainagebag,smokefluidvolumenumber.

Epumpendswithapunctureneedle,localdisinfection,coveringasepticgauze,presshardforamoment,useadhesiveclothtohold.

6postoperativetreatment

Askthepatienttoliedownorhaveahalfhourrest,takethebloodpressureandseeifthereisanychangeinthecondition.

Fillouttheinspectionformaccordingtotheclinicalneedsandsendthespecimen.

Cleanequipmentandoperatingroom.

Makeapiercingrecord.

7pointsforattention

（1）beforetheoperation,thepatientshouldbeshownthepurposeofpuncture,removetheconcern,andsigntheconsentform.Fornervousnervous,itmaybepossibletogivediazepam10mghalfanhourbeforesurgery,or0.03gtocalmthepain.

（2）.Intheoperationshouldcloselyobservethepatient'sreaction,suchaspatientswithdizziness,pale,sweating,heartpalpitations,chest,abdomen,orpain,syncope,pleuralallergicreaction;Continuityorappearthephenomenonsuchascoughandshortnessofbreath,coughPaoMoTan,immediatelystoppumpingliquid,and0.1%adrenalinesubcutaneousinjection0.30.5ml,orothersymptomatictreatment.

Apumpshouldnotbeexcessiveortoofast.Diagnosticextract,50-100ml.Forthefirsttime,nomorethan600mlofdecompression,nomorethan1000mleachtime.Suchaspyothorax,exhausttheasfaraspossibleatatime,suppurativeinfectionissuspected,assistantwithsteriletubestoreturnsamples,linesmeargramstainingmicroscopy,bacterialcultureanddrugsusceptibilitytest.Checkthetumorcells,atleast100ml,andshouldbesentimmediatelytopreventthecellsfromself-soluble.

（4）.strictasepticoperation,mustalwaysmaintainthenegativepressureofthepleuraandpreventairfromenteringthechest.

（5）.Avoidpiercingthroughthe9thribtopreventpenetratingthediaphragmanddamagingtheabdominalcavity.

（6）.Beforeandaftertheoperation,thepatient'svitalsignsaremeasured,andthepatientisinstructedtorestfor30minutes.

（7）formalignantpleuraleffusion,injectableantineoplasticdrugsorhardenerchemicallyinducedpleurisy,promptingdirtylayerandwallpleuraladhesions,closedchest,preventthoracicfluidtoaccumulate.Specificoperation:

aftertheextractionof500to1200ml,thedrug（suchasminoryclin500mg）andthesalinesolutionof20-30dilutedinsalinesolutionwereinjected.Afterpushingintothedrug,redrawthechest,thenpushinagain,2to3times,tokeepthepatientinbedfor2to4hours,andkeepchangingposition,sothatthedrugiscoatedevenlyinthechestcavity.Ifinjectionisstimulant,cancausechestpain,shouldbeinfrontofthemedicinetheanalgesicagentthatgivesstrongpainorpethidine.

Complicationsandprinciplesofmanagement

（1）pneumothorax

Therateofpneumothoraxinthoracicpuncturewas3to20percent.Thecauseisagasfromtheoutside,suchastheleakageofthejoint,thereplacementoftheneedle,ortheimproperuseofthethree-wayplug.Thiskindofcircumstanceusuallydoesnotneedprocessing,theprognosisisgood.Theotheriscausedbythedamageofthepleuraandthelungsintheprocessofpuncture.Asymptomaticpatientsshouldbecloselyobservedandfollowedup.Ifyouhavesymptoms,youmayneedtodoapleuraldrainage.

（2）bleeding,bloodchest

Apuncturewoundcancausebleedinginthelungs,inthechestorinthechest.Asmallamountofbleedingisseeninthechestwallandbleeding,usuallywithouttreatment.Iftheintercostalarterycancausealargeamountofhemorrhage,thebloodofthepleuralcavityisformed,andthebloodcanbestoppedimmediately,andthebloodofthechestcavityispumpedout.Lungdamagecancausehaemoptysis,smallmeasurehaemoptysiscanself-stop,moreseriouspersonpresseshaemoptysisroutineprocessing.

（3）diaphragmaticinjury,liverandotherabdominalvisceralesions

Thelowerpartofthepuncturecancausethediaphragmdamage,theliverandotherabdominalorgans.

（4）thepleuralresponse

Somepatientsexperiencedizziness,paleskin,sweating,palpitations,chestcompressors,severepain,andfainting,whicharecalledpleuralreactions.Itisfoundinnervouspatientswhoaremorelikelytobereflexesforvasculature.Thepunctureshouldbestoppedatthistime,andthepatientwillbetoldtoliedownandabsorboxygen.

（5）chestinfection

Itisaseriouscomplicationthatisfoundinrepeatedthoracicpuncture.Thisistheresultoftheinfectionofthepleuralcavityintheoperation.Oncethewholebodyistreatedwithantibacterial