Pleural puncture (pediatrics)

Scheme of puncture of an extensive left-sided pneumothorax

child is in a supine position;
if there is time, we will perform adequate analgosedation;
the injection is made above the upper edge of the rib in the medioclavicular line in the 2nd-3rd. intercostals.

The upper edge of the rib must be respected because of possible injury to the nerve-vascular bundle that runs along the lower edge of the rib

2nd intercostal is located immediately below the clavicle;
we preferably use i.v. "blue" cannula (22G cannula for newborns, 18G cannula for the elderly);
after penetration into the interpleural space, we pull out the needle and introduce the cannula deeper;
urgent air evacuation is carried out using a syringe, otherwise it is better to connect the cannula using a connecting tube and a three-way cock to a 20 ml syringe, which we then evacuate the air;
in the case of a super-urgency with a tension PNO, we convert the tension PNO to an open one using a needle or, better, a set of needles.

Drainage systems in pediatric patients

Definitive treatment consists in the introduction of a chest drain with active suction;

the patient is in a supine position, the affected side can be slightly supported, the hand on the affected side is raised behind the head;
the injection site is the 4th or 5th intercostal space between the front and middle axillary lines, we disinfect the injection site, cover and infiltrate with 1% mesocaine;
at the injection site, we make a small horizontal skin incision with a scalpel, through it we then bluntly penetrate the upper edge of the rib (again, we must protect the nerve-vascular bundle running along the lower edge); drain is captured in the pean and introduced into the pleural cavity;
penetration is manifested by a sudden loss of resistance;
we close the incision, fix the drain and connect it to continuous suction with negative pressure (system according to Bülau or aqua seal).

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