SECTION IV 



SURGERY OF THE THORAX AND ABDOMEN 

 Paracentesis Thoracis 



THIS simple and harmless operation is performed 

 for the purpose of removing fluid from the 

 thoracic cavity. It may be repeated with perfect 

 safety as often as circumstances require, provided 

 that rigid asepsis is maintained. 



The patient must be in the standing position, but 

 held firmly by an assistant. Apply a local anes- 

 thesia of ethyl chlorid spray, and have at hand a 

 trocar and cannula, a razor, swabs, and iodized 

 collodion. 



Technic. — The point of puncture on either side is 

 the intercostal space between the seventh and eighth 

 rib. Shave and disinfect an area two inches square. 

 Pull the skin backwards and introduce the sterilized 

 trocar and cannula into the thoracic cavity, taking 

 care to make the puncture midway between the ribs, 

 thus avoiding the vessels and nerves. Withdraw 

 the trocar, and allow the fluid to flow away. 



A small trocar and cannula must be used, for 

 otherwise the evacuation of the fluid is so rapid as 

 to produce syncope and sometimes a fatal result. 

 There is little danger of wounding the lung, as it 

 is floated up and compressed by the fluid and is 

 therefore well above the line of puncture. 



In withdrawing the cannula, the fingers should 

 press the skin down firmly on either side of it, to 

 prevent its separating the skin from the muscles. 

 It will be seen that after the cannula is withdrawn 

 the puncture in the skin and that in the muscles 



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