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A chest tube or drain is inserted when a cat has breathing difficulties due to fluid or air building up in the space outside the lungs. Fluid or air in the pleural space prevents the lungs expanding fully and causes respiratory distress. Draining the fluid or air allows the lungs to expand and the cat to breathe normally.
There are a number of conditions that may need a chest drain. In some cases, the chest only needs to be drained once or twice, in which case thoracocentesis (inserting a needle or catheter attached to a syringe) may be sufficient. However, for conditions in which the fluid or air is liable to build up again, then a chest drain that is left in place is a better, less traumatic option.
A chest drain may be placed under local anesthetic with the cat sedated. This procedure is frequently done in first opinion practice.
If the cat is in extreme respiratory distress and the clinical exam suggests air or fluid in the chest, then the clinician may place a chest drain as an emergency procedure in order to stabilize the patient. If the cat is not in a crisis then chest radiographs may be performed prior to placement in order to gather more information.
To place the tube the cat is sedated, the hair over both sides of the chest clipped, and local anesthetic infiltrated into the skin. A small nick is made in the skin overlying the tenth rib, and the chest drain passed through the skin and burrowed forward to around the seventh and eighth rib. This produces a skin tunnel which helps prevent air leaking around the tube and into the chest.
The chest drain is then elevated at 90 degrees to the chest way and with controlled pressure driven 1cm or so through the muscles between the ribs and into the chest. The tube is then positioned parallel to the chest and advanced to the hub. The stylet inside the tube is removed and the hub connected to a three-way tap and a syringe.
The fluid or air is then drawn off the chest. Once a satisfactory result is obtained, the tube is plugged with a bung, sutured in place, and covered with a dressing.
If necessary, the tube placement is repeated on the opposite side.
Placing a chest tube can be life saving. It is also an important way to improve the quality of life for a cat that is struggling to breathe. Chest tubes may be left in position for several days, provided they are managed aseptically so the risk of introducing infection into the chest is minimized.
The alternative is to a chest drain is thoracentesis. This means injecting local anesthetic each time, and passing a needle or catheter through the chest wall repeatedly. This can be painful and the cat learns to anticipate the feelings of discomfort and become anxious. Thus, for those patients which repeat draining is likely to be needed, the chest tube offers the better option.
Placing a chest tube is a moderately invasive procedure. However, the net gain from being able to breathe more easily means that most cats recover quickly and are more comfortable for it.
It is a good idea to give the cat ongoing pain relief whilst the chest drain is in place, to ensure they stay comfortable. It is also important that the cat does not interfere with the drain. To this end, a dressing over the chest is helpful or the cat must wear a cone.
Sedation of a high risk feline patient can cost from $99 to $200. Chest radiographs, depending on the number of plates, costs around $80 - $250. Placing a chest drain itself is from $150 upwards.
A chest drain can be life-saving. However, it is a salvage procedure to improve quality of life, rather than a treatment in its own right. The exception being a trauma that causes a small lung tear, in which case draining the pneumothorax (air in the chest cavity) can be sufficient for the lung to recover and repair itself.
There are drawbacks to a chest tube, namely the risk of introducing infection into the chest or leakage of air around the tube causing a pneumothorax. However, these risks can be minimized with good placement technique and excellent nursing care.
Traumatic episodes such as a traffic accident can cause lung lacerations or damage to the chyle duct. Thus, supervising cats when outdoors can go a great way to reducing the risk of trauma and the need for a chest drain.
Another cause of fluid in the chest is FIP. This condition affects young cats and the risk is greatest when the kitten was acquired from a multi-cat house, breeder, or shelter, where several cats share the same litter box. It is good policy for anyone considering getting a kitten, to quiz the breeder over the incidence of FIP or even the breeding queen testing positive for coronavirus. Use common sense when selecting a kitten and avoid those housed in unsanitary or overcrowded conditions.
Likewise, an owner should be alert for signs of breathing difficulties and get their cat checked by a vet. Identifying problems, such as heart disease, in the early stages can mean starting effective treatment to avoid a pleural effusion from occurring.
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