Pleural puncture (pediatrics)
- Urgent indication
- pneumothorax, especially tension.
- child is in a supine position;
- if there is time, we will perform adequate analgosedation;
- the injection is made above the upper edge of the rib in the medioclavicular line in the 2nd-3rd. intercostals.
- 2nd intercostal is located immediately below the clavicle;
- we preferably use i.v. "blue" cannula (22G cannula for newborns, 18G cannula for the elderly);
- after penetration into the interpleural space, we pull out the needle and introduce the cannula deeper;
- urgent air evacuation is carried out using a syringe, otherwise it is better to connect the cannula using a connecting tube and a three-way cock to a 20 ml syringe, which we then evacuate the air;
- in the case of a super-urgency with a tension PNO, we convert the tension PNO to an open one using a needle or, better, a set of needles.
Definitive treatment consists in the introduction of a chest drain with active suction;
- the patient is in a supine position, the affected side can be slightly supported, the hand on the affected side is raised behind the head;
- the injection site is the 4th or 5th intercostal space between the front and middle axillary lines, we disinfect the injection site, cover and infiltrate with 1% mesocaine;
- at the injection site, we make a small horizontal skin incision with a scalpel, through it we then bluntly penetrate the upper edge of the rib (again, we must protect the nerve-vascular bundle running along the lower edge); drain is captured in the pean and introduced into the pleural cavity;
- penetration is manifested by a sudden loss of resistance;
- we close the incision, fix the drain and connect it to continuous suction with negative pressure (system according to Bülau or aqua seal).
Links[edit | edit source]
Source[edit | edit source]
- HAVRÁNEK, Jiří: Pleural puncture. (edited)