Safety guidelines for thoracic puncture needles

(1) Before puncture: understand the patient's psychological state, explain the purpose of puncture to the patient, introduce the operation method, explain the matters needing attention, and eliminate the patient's thoughts and concerns. For patients with mental tension, through persuasion, demonstration, induction and other methods, give spiritual comfort, eliminate tension, fear, talk with patients, encourage patients to breathe deeply, so that patients learn to relax; Assist the patient to take a comfortable sitting position or high occipito-lateral decubitus position to avoid the patient seeing surgical instruments and thoracic fluid and divert their attention [1].

(2) targeted: chest cough when wear easy cause lung inflation, needle damage lung tissue, instruct patients in the process of piercing don't cough, take a deep breath, or talk, when it is necessary to hand to inform surgeons, namely to drink cold water, when the patient to cough can relieve a cough, cough before to subcutaneous needle, rough cough should pull out the needle to stop operation. During thoracotomy, patients' vital signs such as pulse, respiration and blood pressure should be closely observed to prevent excessive tension, shock, dyspnea and other symptoms. Observe patients closely for any pleural reactions such as dizziness, palpitation, chest tightness, pallor, sweating, irritant dry cough, or even fainting. If the patient has the above symptoms, stop pumping fluid immediately, pull out the puncture needle, press the puncture site with sterile gauze, assist the patient to lie down, give low-flow oxygen 2-5L/min, and give ecg monitoring if necessary. Patients with hypotension and shock were given 0.1% epinephrine 0.5 mg subcutaneously, and treated with hormones and fluid rehydration. Controlling the rate of fluid and air extraction can avoid the occurrence of retentive pulmonary edema and hypotension. The first time of air and liquid extraction should not exceed 800 ~ 1000ml (except traffic and tension pneumothorax), and the time of liquid extraction should be controlled within at least 1h. For patients with poor cardiac function, the volume of initial air and fluid extraction should be smaller, and 600ml is safer. If the patient has dry cough or choking cough during decompression, which is an early sign of retentive pulmonary edema, decompression should be stopped immediately, generally, retentive pulmonary edema and hypotension will not occur. In case of pulmonary edema, the operation should be stopped immediately and corresponding rescue should be prepared. Patients with pulmonary edema should be given alcohol humidified oxygen, intravenous aminophylline, cardiotonic, and furosemide as prescribed. Timely treatment of pulmonary edema, to avoid aggravating the primary disease caused by accident. If more fluid and gas are considered, thoracic closed drainage should be performed as far as possible to reduce the incidence of complications. When the biopsy needle is pulled out from the pleural cavity, the biopsy hole should be blocked immediately with one hand thumb and pressed for 15 minutes, which helps to reduce the occurrence of pneumothorax.

(3) After the puncture: after the puncture, assist the patient to lie prone on the bed and ask him to rest in bed for about two hours, closely observe the changes of the patient's vital signs and chest signs, especially the changes of body temperature and respiration, listen to the patient's complaints, and detect various complications as soon as possible. Pay attention to whether there is blood seepage and fluid leakage at the puncture site. If the patient is free in manner and breathing is stable, then instruct him to move out of bed. For patients with syncope in the middle of the surgery, the patient should be assisted to rest in bed and continue observation for 30min; For patients with hypotension during thoracotomy, oxygen inhalation and fluid rehydration should be continued after surgery. For patients with pneumothorax, bleeding and liver injury during thoracotomy, corresponding treatment and nursing should be taken after the operation, and the changes of the patient's condition should be closely observed. Timely inform patients of the puncture results, pay attention to the patients' thoughts and mentality, take the initiative to care for them, encourage them to face the reality bravely, adapt to life, eliminate psychological burden, treat the disease with a positive attitude, and strive for an early recovery.

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