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(a) Track through chest wall

The key to avoiding sputum retention is good postoperative analgesia. There are some situations where coughing post-operatively is particularly difficult, such as if there has been damage to the recurrent laryngeal nerve during the course of a pulmonary resection. This may have been deliberate when glands from the aortopulmonary area have been involved and are removed. Patients with increased or tenacious sputum need either repeat nasolaryngeal suction or minitra-cheostomy. The latter can be inserted using a Seldinger technique through the cricothyroid membrane which is the most comfortable procedure for the patient.

A bronchopleural fistula may occur because of faulty technique, infection or because the suture line has become involved with tumour. The most important bronchopleural fistula occurs after a pneumonectomy when the post-pneumonectomy space will become infected. The patient characteristically coughs up serosanguineous fluid and a chest

(ii)
Figure 18.11. (a) Track for insertion of Intercostal catheter. (b) (i) Approach for HATS and (ii) Passing fingers thru diaphragm. (c) (i) Dumon stent and (ii) Wallstent.

From patient

To wall suction

From patient

To wall suction

Level of suction

Suction regulation

Figure 18.12. Three-bottle system of underwater sealed drainage.

Level of suction

Suction regulation

Figure 18.12. Three-bottle system of underwater sealed drainage.

it is generally wise to have a ventilation-perfusion scan to ensure that the remaining lung is normal and get an assessment as to the effectiveness of the remaining lung.

Lesser procedures include segmental resection of an anatomical segment of a lobe of lung and wedge resections. Persistent air-leaks used to be a problem with them but the use of staplers and tissue glues has improved their safety.

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