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The CT report stated that the left-sided thoracostomy tube was functional; however, the right-sided thoracostomy tube was stated to be possibly occluded by the diaphragm, which could have contributed to the previous inadequate evacuation of the pleural space. every 4 – 6 hours, and the volume of air and fluid drained was recorded. General thoracostomy tube management was performed as discussed on page 33. The thoracostomy tube site and surgical wound were assessed and re-dressed every 24 hours( Figure 5).
Following the CT report, the VS opted to proceed with surgical intervention. Duke underwent a median sternotomy and a right accessory lung lobectomy. Following removal of the damaged lung lobe and closure of the thorax, the pleural cavity was drained and negative pressure was achieved.
Postoperative care
Postoperative care following thoracic surgery centres around patient stability and comfort. The main nursing considerations for Duke in the immediate postoperative period included:
• Monitoring cardiovascular stability
• Monitoring ventilation and oxygenation
• Pain assessment and management
• Thoracostomy tube management.
As for all postsurgical patients, a clean, comfortable environment should be prepared [ 10 ]. In recovery, the patient should be positioned in a way that allows inflation of both lungs, to promote adequate ventilation [ 11 ]. The patient ' s respiratory rate, effort, pattern and oxygenation status should be monitored [ 11 ].
Oxygenation can be assessed by using pulse oximetry or arterial blood gas analysis [ 10 ]. Various methods of oxygen supplementation are available, including flowby oxygenation or provision of oxygen via a mask, nasal prongs, nasal cannulas or an oxygen cage [ 10 ]. The method selected will depend on factors such as the patient ' s condition, tolerance of the different methods and long-term needs, and the practice ' s facilities. A higher fraction of inspired oxygen( FiO 2
) may be achieved by certain methods, such as nasal prongs or nasal cannulas, compared with flow-by oxygenation. The method selected should be one that is effective and meets the requirements of the patient without causing them additional stress.
Once the patient has recovered from anaesthesia, the frequency and type of ongoing monitoring may be dictated by their stability. Duke had a respiratory assessment performed hourly for the first few hours postoperatively, and assessments were then reduced in frequency to every 2 hours overnight. His ventilation and oxygenation were deemed appropriate throughout the whole postoperative period. His heart rate, pulse quality, temperature and blood pressure were assessed every 4 – 6 hours, which allowed time for rest, which is essential to recovery. Thoracic drainage was performed
Figure 5. Thoracostomy tube and dressing.
Patient comfort is an essential consideration following major thoracic surgery [ 11 ]. As discussed above, regular pain assessments should be performed using a validated pain-assessment tool. An individualised multimodal analgesia plan is often preferential for postoperative patients. Certain drugs, such as opioids, can have profound side effects when used at higher doses; using a multimodal technique allows lower doses of each analgesic drug to be given and a consequent reduction in undesired side effects. Duke ' s analgesia plan was comprehensive and consisted of:
• Methadone( Comfortan, Dechra) 0.2 mg / kg IV q4h
• Ketamine( Anesketin, Dechra) 5 μg / kg / min CRI
• Paracetamol( B. Braun) 15 mg / kg IV q8h
• Bupivacaine hydrochloride( Bupivacaine 0.5 %, MercuryPharma) 1.5 mg / kg( diluted 50:50 with sterile saline) delivered via the thoracostomy tube
• Meloxicam( Metacam, Boehringer Ingelheim) 0.1 mg / kg orally q24h.
Duke ' s pain levels were well managed in the postoperative period. His analgesia was gradually reduced over 48 hours following surgery based on his pain scores. Duke remained comfortable and bright, and recovered remarkably well from his surgery. His nursing care requirements were evaluated frequently and interventions were tailored to his specific needs.
Volume 41( 5) • October 2026
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