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Thoracic Surgery

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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 ... – PowerPoint PPT presentation

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Title: Thoracic Surgery


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 GroupingTNM Subsets
  • Stage 0 (TisN0M0)
  • Stage IA (T1N0M0)
  • Stage IB (T2N0M0)
  • Stage IIA (T1N1M0)
  • Stage IIB (T2N1M0, T3N0M0)
  • Stage IIIA (T3N1M0), (T(13)N2M0)
  • Stage IIIB (T4, Any N, M0) (Any T, N3M0)
  • Stage IV (Any T, Any N, M1)

17
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18
Survival
Stage 5 year Survival
1 A, B 60-85
II A,B 40-60
III A 10-40
III B lt10
IV lt5
19
Fitness for Surgery
  • Age
  • Pulmonary function
  • Cardiovascular function
  • Medical conditions
  • Nutritional Status
  • Performance status

20
Assessment of Operability
  • CT scan
  • Bone scan
  • PET scan
  • Mediastinoscopy
  • Anterior Mediastinotomy
  • VATS

21
Pleural effusions
  • Fluid in chest
  • Due to underlying cause
  • Usually malignant, but what ?
  • Drain for
  • Symptoms
  • Diagnosis

22
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23
Pneumothorax
  • What is a pneumothorax ?
  • How do you treat them ?
  • Who requires surgery ?
  • What does surgery entail ?
  • Thoracotomy
  • Sternotomy
  • Mini thoracotomy
  • VATS

24
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25
Lung biopsies
  • Need tissue to diagnose Interstitial lung
    disease

26
Bronchoscopy
27
oesophagoscopy
28
Mediastinoscopy
29
Mediastinoscopy
30
Mediastinotomy
31
Mediastinotomy / Chamberlains
32
Thoracoscopy
33
Video Assisted Thoracic Surgery
34
Thoracotomy
Posterolateral Lateral Anterolateral Mini
thoracotomy Muscle sparing
35
Thoracotomy - Posterolateral
36
Thoracotomy - Anterolateral
37
Mini thoracotomy
  • Small incision thoracotomy

38
Lung Resection
  • Pneumonectomy
  • Lobectomy
  • Wedge

39
Lung Resection Pneumonectomy
Intrapericardial Extrapericardial No
reserve Sputum pO2 Fluid balance Infiltrates Tempe
rature AF
40
Lung Resection Lobectomy
3 Lobes on RT RUL RML RLL (not RUL RLL) 2
lobes on LT LUL LLL
41
Wedge resection
42
Thymectomy
  • Thymic masses
  • Myaesthenia Gravis
  • Oddities like Pure Red Cell Aplasia

43
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44
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45
Thymectomy
46
Chest drains
  • What are they ?
  • Why use them ?
  • Suction and its role
  • What drain do you take out MARK IT

47
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48
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

49
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

50
Chest Drain
51
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

52
Does and Donts 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

53
Drain Removaland Timing of Drain Removal
54
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

55
On Inspiration
  • Easy to hold breath on maximal inspiration
  • Pleural pressure most negative therefore air more
    likely to move into pleural space

56
Valsalva Manoeuvre
  • Forced expiration against a closed glottis
  • Creates a positive intrapleural pressure
  • Easy for patient to hold

57
Post operative care
  • Blood pressure
  • Blood gases / saturation
  • Urine output
  • Bleeding
  • Sputum
  • Analgesia

58
Questions ? Any
59
Next week Thursday 16th November12.00 to
1.00pm Oesophageal SurgeryLecture Theatre
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