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Thoracic Surgery

Thoracic Surgery. Overview. What is it ? What do you need to know as a nurse on the ward ?. What do you need to know as a nurse on the ward ?. Different pathologies Different operations Chest drains Post operative care. Different pathologies. Lung cancer Pneumothorax Pleural effusions

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Thoracic Surgery

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  1. Thoracic Surgery

  2. Overview • What is it ? • What do you need to know as a nurse on the ward ?

  3. What do you need to know as a nurse on the ward ? • Different pathologies • Different operations • Chest drains • Post operative care

  4. Different pathologies • Lung cancer • Pneumothorax • Pleural effusions • Lung biopsies • Trauma • Oddities

  5. Different operations • Bronchoscopy (oesophagoscopy) • Mediasteinoscopy • Mediasteinotomy / Chamberlains • Thoracoscopy VATS • Mini thoracotomy • Full thoracotomy • Pneumonectomy / Lobectomy / Wedge

  6. Anatomy • Trachea • 2 bronchi • 2 Lungs • 2 lobes on left • 3 lobes on right

  7. The Right Lung

  8. The Left Lung

  9. Bronchial system

  10. Compartments of the chest

  11. Lung cancer • Small cell • Non small cell • Squamous • Adeno • Large cell • Undifferentiated

  12. Lung cancer • Except for small cell carcinoma of the lung it is generally accepted that surgery is the most effective therapy for lung carcinoma

  13. Small Cell Lung Cancer

  14. Assessment of Patient • Fitness for surgery • Operability of the tumour - Staging

  15. Staging • TNM • T size and position of tumour • N lymph node status • M metastasis

  16. Stages • Stage Grouping—TNM Subsets • Stage 0 (TisN0M0) • Stage IA (T1N0M0) • Stage IB (T2N0M0) • Stage IIA (T1N1M0) • Stage IIB (T2N1M0, T3N0M0) • Stage IIIA (T3N1M0), (T(1–3)N2M0) • Stage IIIB (T4, Any N, M0) (Any T, N3M0) • Stage IV (Any T, Any N, M1)

  17. Survival

  18. Fitness for Surgery • Age • Pulmonary function • Cardiovascular function • Medical conditions • Nutritional Status • Performance status

  19. Assessment of Operability • CT scan • Bone scan • PET scan • Mediastinoscopy • Anterior Mediastinotomy • VATS

  20. Pleural effusions • Fluid in chest • Due to underlying cause • Usually malignant, but what ? • Drain for • Symptoms • Diagnosis

  21. Pneumothorax • What is a pneumothorax ? • How do you treat them ? • Who requires surgery ? • What does surgery entail ? • Thoracotomy • Sternotomy • Mini thoracotomy • VATS

  22. Lung biopsies • Need tissue to diagnose “Interstitial lung disease”

  23. Bronchoscopy

  24. oesophagoscopy

  25. Mediastinoscopy

  26. Mediastinoscopy

  27. Mediastinotomy / Chamberlains

  28. Mediastinotomy

  29. Thoracoscopy

  30. Video Assisted Thoracic Surgery

  31. Thoracotomy Posterolateral Lateral Anterolateral Mini thoracotomy

  32. Thoracotomy - Posterolateral

  33. Thoracotomy - Anterolateral

  34. Mini thoracotomy • Small incision thoracotomy

  35. Lung Resection • Pneumonectomy • Lobectomy • Wedge

  36. Lung Resection – Pneumonectomy Intrapericardial Extrapericardial No reserve Sputum pO2 Fluid balance Infiltrates Temperature AF

  37. Lung Resection – Lobectomy 3 Lobes on RT RUL RML RLL (not RUL & RLL) 2 lobes on LT LUL LLL

  38. Wedge resection

  39. Chest drains • What are they ? • Why use them ? • Suction and its role • What drain do you take out MARK IT

  40. Function • Conduit to remove fluid or air from the pleural or pericardial spaces • The fluid may be blood, pus or pleural effusion • Allow the lungs and heart to work unrestricted

  41. Spaces That Need Draining Following Thoracic Surgery • Only a single pleural cavity opened • Air and blood may collect in the space • Two drains • Apical drain – Air • Basal drain – Blood • Traditionally apical drain is placed anteriorly and basal drain at the back

  42. Chest Drain

  43. Suction • What does it do? • Makes the external pressure negative • Air or blood drains more easily out of chest Dangers • If on to high tissues may get sucked into the drain damaging them • If connected but not on similar effect to clamping the drains • BEWARE PNEUMONECTOMY

  44. Does and Don’ts of Chest Drains • Do not clamp a functioning drain as this can lead to a tamponade or a tension pneumothorax • If becomes disconnected, reconnect and ask patient to cough • Always keep drain below level of patient • If raised above patient the contents may siphon back into the chest

  45. Drain Removaland Timing of Drain Removal

  46. On Expiration • Pleural pressures at their highest • But still less than atmospheric pressure • Difficult to hold breath at full expiration • Natural reaction to pain is to take a deep breath in

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