Performing punctures

Puncture of abdominal cavity( laparocentesis)

Applied with ascites.

The following tools are needed: scalpel, needle holder, skin needle, silk No. 4( 1 ampoule), surgical tweezers, trocar, rubber catheter, 3-4 gauze balls, scissors, oilcloth apron. The patient is seated on a stool so that his back rests against the dressing table. Around the waist at the level of the inguinal folds are fastened an oilcloth apron covering the patient's legs. The edges of the apron should hang in the pelvis, set at the feet of the patient. Prepare the surgical field on the patient's stomach. The surgeon, after processing his hands, produces local anesthesia, then with a scalpel cuts the skin at the site of the proposed puncture.

Puncture is produced by a trocar, consisting of a metal tube on which a steel rod with a sharp end slides. After puncture, the stiletto is removed, the fluid is released slowly, approximately 1 ml in 5 minutes, for this purpose, periodically cover the outer tube opening with a ball on the surgical tweezers. When the discharge is stopped, the fluid is checked to see if the opening is closed with the gut or a seal of the gland, for this use a soft rubber catheter. After removing the tube, the surgeon applies two silk seams to the skin, after processing the seams, puts a small napkin.

Puncture of the pleural cavity( thoracocentesis)

Tools: two 20 ml syringes, one with 0.5% solution of novocaine, the second - empty, a needle for punctures with a rubber tube and a cannula, a hemostatic clamp. The patient sits, bending slightly forward, raised on the side of the puncture, the hand is held by the nurse. Preparation of the hands of the surgeon and the operating field are normal. After local anesthesia with novocaine, the surgeon takes a puncture needle with a tube clamped by the clamp and punctures the pleural cavity. Then he hands the clamp, which lies on the tube, into the hands of the dressing sister. This nipple is opened by the nurse at the moment the surgeon sucks the fluid and air from the pleural cavity, and closes it at the Provision of the surgeon. Evacuate the liquid should be slow( 1 liter for 15 minutes), from time to time stopping aspiration. After removing the needle, the puncture site is treated with iodinol and carefully sealed.

Constant drainage of the pleural cavity with pneumothorax. Instruments: syringe with 0.5% solution of novocaine, trocar, polyvinylchloride drainage tube 20-25 cm long with numerous holes for 8-10 cm, scalpel, needle holder, skin needle, silk No. 4( 1 ampoule), three hemostaticclamping, scissors. The patient lies face up on the dressing table, stretching his arms along the trunk, preparing the surgical field and the surgeon's arms usual. At the end of the chlorovinyl tube, a hemostatic clamp is applied. After local anesthesia in the area of ​​the II intercostal space with a solution of novocaine, the surgeon makes a puncture of the skin with a scalpel, at the corners of this puncture, imposes two silk skin seams, taking them on the clip No. 2, and through this incision the trocar conducts into the pleural cavity. Upon removal of the Trocart trochaude, the surgeon covers the hole in the trocar tube with a sterile napkin, the nurse sends a drainage with the clamp No. 1 applied to it. The surgeon quickly conducts the drainage into the pleural cavity, removes the trocar tube and, intercepting the clip No. 3 so that it does not remainopen, fixes this drainage to two pre-imposed skin seams. After treatment with iodine in the drainage circle, a small napkin cut into half is pasted onto the site of its standing.

Puncture of the pericardium

The patient is placed horizontally on the back, lifting the head end of the dressing table. Under the back, at the level of the lower ribs, a small roller is placed. Before puncturing the patient through the probe, empty the stomach. After processing the surgical field, the surgeon takes a 20 ml syringe filled with a 0.5% solution of novocaine. With a fine needle, the surgeon performs skin anesthesia at the base of the xiphoid process, takes a needle 10-12 cm long and 1-1.5 mm in diameter and along with the syringe moves it along the back surface of the sternum, presuming a solution of novocaine. Passing 2-3 cm, the needle pierces the pericardium, and the syringe begins to receive blood or exudate. Aspirate the exudate slowly, usually remove 100-400 ml of fluid. The puncture site is treated with antiseptics and glued with a glue.

Novocaine poisoning. After 30-40 seconds after the injection, the patient feels malaise, a feeling of cold, dizziness, cold sweat, intermittent breathing. Sometimes confusion and excitement. It is necessary to inject subcutaneously or intramuscularly caffeine, cordiamine, give oxygen, inhale ammonia.