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Open pleural drainage (also known as open chest drainage) is a surgical procedure that involves creating a permanent opening in the chest wall to drain air, fluid, or pus from your pleural cavity (area around the lungs).
The pleural cavity is the space lying between the pleura (two thin layers that surround the lungs). This space contains a small amount of liquid known as the pleural fluid, which acts as a lubricant for the expansion and contraction of the lungs during respiration.
When there is an excessive collection of the pleural fluid or build-up of air, blood, or pus in your pleural cavity, you might face difficulty in breathing. A procedure like open pleural drainage eases your breathing.
Although open pleural drainage is less commonly used nowadays because of appropriate antibiotic usage and use of alternative techniques (thoracostomy and thoracotomy), it is still reserved for very ill patients who cannot undergo any other procedure to drain their pleural cavity.
When do you need open pleural drainage?
You need pleural drainage if you suffer from the below conditions:
- Pleural effusion: It is an excessive collection of the pleural fluid in the pleural cavity.
- Pneumothorax: It is leakage of air in the pleural activity.
- Hemothorax: It is a collection of blood in the pleural cavity.
- Empyema: It is a collection of pus in the pleural cavity.
You will need open pleural drainage when you are so debilitated that you cannot undergo an extensive surgical procedure for draining your pleural fluid.
Your doctor will prefer open pleural drainage over other techniques if
- If you suffer from severe nutritional deficiency.
- If you need pleural drainage for long term.
- If you have developed pus in the pleura after lung procedures (post-pneumonectomy empyema).
What is done before open pleural drainage?
Before the procedure, these steps will be administered:
- Your doctor will examine and look for your present signs and symptoms. He will order an X-ray and computed tomography (CT scan) of your chest to decide the best approach for your open pleural drainage.
- You and your family will be explained about the procedure and its complications, and your written consent will be taken officially for the same.
How is open pleural drainage performed?
Once examination is complete, the procedure will be performed.
- You will be told to sit at 45° angle with your arm raised behind the head to expose the armpit area (in a forward lean position).
- The skin of your back will be cleaned with an antiseptic solution.
- Anesthetics solution will be injected locally to numb the area where the drain will be inserted. This will make the procedure less painful for you.
- Your doctor may also give you painkillers and sedatives.
- The doctor will make a large U-shaped incision (5 cm wide and 6-7 cm long) known as an Eloesser flap. Optionally, doctors can make an H-shaped or inverted U-shaped incision.
- Through the incision, a segment of the rib will be removed, and the skin flaps will then be sutured to the pleura and the remaining edges of skin sutured together. This is done to prevent pneumothorax (air entry in the pleura).
- The wound will be left open to allow the drainage as required (for several days) or permanently.
What is done after open pleural drainage?
After the procedure is complete, without complication, follow up is then performed.
- A chest X-ray will be performed regularly followed by chest computed tomography (CT scan) to confirm the resolution of your original disease.
What are the complications of open pleural drainage?
Generally, open pleural drainage will be well-tolerated by you. Some of the complications that may arise include:
- Pneumothorax (collection of air in the pleura)
- Inadequate drainage of pus in empyema
- Irritation of the surrounding skin
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Guidelines for the Insertion and Management of Chest Drains. Available at: https://www.dbth.nhs.uk/wp-content/uploads/2017/07/PAT-T-29-v.1-Chest-Drains-Guidance-incl-changes-TJN-review-date-extended.pdf
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