Use of continuous thoracic drainage in the patient
As Duke had a persistent pneumothorax, the VS opted to use the continuous thoracic drainage system( Figure 3).
of normal and / or abnormal lung sounds. His other vital signs were recorded every 4 – 6 hours. Duke experienced periods of dyspnoea overnight, and the ICU team responded rapidly to troubleshoot issues with the continuous thoracic drainage system.
Pain assessment and management are important considerations when nursing a patient with a thoracostomy tube, particularly those that have sustained traumatic injuries [ 7 ]. Pain can influence respiration and can lead to tachypnoea and erratic breathing, with subsequent reductions in tidal volume and oxygen intake. Pain scoring was therefore performed on Duke every 4 hours overnight using the Glasgow Composite Pain Scale [ 9 ]. Methadone( Comfortan, Dechra), an opioid analgesic, was administered at 0.2 mg / kg IV as required based on the pain scores.
Further interventions
Figure 3. Duke attached to the continuous thoracic drainage system.
Due to the dynamic nature of the condition and the associated risks, close monitoring was vital, so Duke was hospitalised in the ICU. He was placed on a raised bed, ensuring he was above the level of the drainage unit [ 8 ]. The system was assessed continuously, and findings were consistent with a persistent pneumothorax. A hands-off assessment of Duke ' s respiratory rate, effort and pattern was performed and recorded hourly, and auscultation was performed to evaluate the presence
Duke ' s pneumothorax persisted the following day and management was becoming increasingly difficult. The VS decided to proceed with a computed tomography( CT) scan. Duke was sedated with 0.2 mg / kg methadone( Comfortan, Dechra, 10 mg / ml) and 0.005 mg / kg dexmedetomidine( Dexdomitor, Zoetis, 0.5 mg / ml), both given IV. Anaesthesia was induced with 0.5 mg / kg alfaxalone( Alfaxan Multidose, Jurox, 10 mg / ml), given IV. A constant-rate infusion( CRI) of propofol( Propofol-Lipuro Vet, Virbac / B. Braun, 10 mg / ml) at a dose of 0.15 mg / kg / min was then used to maintain anaesthesia, to avoid accidental exposure of personnel to volatile agents during the patient ' s anaesthesia.
The CT scan revealed a bilateral large pneumothorax and a pneumomediastinum, with associated lung collapse( Figure 4). Multiple areas of lung contusions and likely traumatic bullae formation were noted.
Figure 4. Computed tomographic images. Transverse( left) and dorsal( right) reconstructions showing likely traumatic bullae formation in the left caudal( green arrows) and right caudal( purple arrows) lung lobes, as well as lung collapse.
34 Veterinary Nursing Journal