① Pneumothorax, hemothorax or empyema need continuous exhaust, blood discharge or pus discharge;
② those who cut pleural cavity. Closed thoracic drainage method: according to the signs and chest X-ray examination, determine the position of gas and liquid in pleural cavity and select the intercostal space of intubation. The fluid is in a low position, and it is usually drained through the eighth intercostal cannula between the axillary midline and the axillary posterior line. Gas accumulates upward, so it should be drained in the anterior superior pleural cavity, and the second intercostal space of clavicle midline is often selected. The patient took a semi-supine position, disinfected his chest, and infiltrated the whole chest wall with 3 ~ 5 ml L% procaine solution in the selected intercostal space. Make a small incision about 2cm long, insert a vascular clamp to separate the muscle layer, and then enter the pleural cavity along the upper edge of the rib. Insert a rubber tube or plastic tube with a side hole into the pleural cavity 4 ~ 5 cm through the incision, and its outer end is connected with a sterile water seal bottle or drainage device. Suture the incision and fix the drainage tube.
The standard water-sealed bottle for thoracic drainage is a big mouth bottle with a capacity of several liters. There are two holes in the rubber plug, which are inserted into the long and short glass tubes respectively. The lower end of the long tube is inserted 3 ~ 4 cm below the horizontal plane, and the lower opening of the short tube is far away from the horizontal plane, so that the space in the bottle is communicated with the atmosphere. When in use, the thoracic drainage tube is connected to the long glass tube of the water-sealed bottle. After the connection, it can be seen on the water column in the long pipe, which is 8 ~ 10 cm above the water surface and moves up and down with breathing. If the water column does not move, the drainage tube is blocked. In order to keep the lumen unobstructed and avoid blockage, the drainage tube should be squeezed frequently. Record the hourly or daily displacement. In order to maintain a certain negative pressure continuously, expel the gas and liquid in pleural cavity and promote lung expansion, a negative pressure suction device can be added. The traditional method is to connect the water seal bottle to the negative pressure regulating bottle. The adjusting bottle is also a big mouth bottle, with three holes in the rubber plug and three glass tubes inserted. The two short ones are respectively connected with the short glass tube on the water-sealed bottle and the negative pressure aspirator. The upper end of the long glass tube is communicated with the atmosphere, and the lower end is inserted under the water surface (10 ~ 20 cm), and the suction negative pressure is adjusted according to the depth of the water column. At present, there are many disposable plastic pleural drainage devices used in clinic.
After pleural drainage, if the water column stops fluctuating within 24 hours and no gas or (and) liquid is discharged, the drainage tube can be removed by X-ray examination. When extubating, ask the patient to take a deep breath and hold his breath, then quickly pull out the drainage tube, immediately cover the wound with vaseline gauze and fix it with adhesive tape, or tighten the suture that has been placed at the incision of the drainage tube.