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13. Tie one tail of each of the purse-string sutures to one tail of each of the suture aid
sutures (
this is why using different colored sutures can be helpful
) to further secure
the catheter in place.
14. Ensure that the catheter is placed securely in the heart wall and that all bleeding has
stopped, and cut the stay suture aid suture and purse string suture tails. If necessary,
an additional purse-string suture can be placed.
15. Optimize the orientation of the catheter so that the catheter is perpendicular to the heart
wall.
Closure of Thoracic Access
Trans-diaphragmatic Approach
Thoracotomy
16a. Prior to closing the diaphragm, any
blood should be gently removed from the
chest cavity. Stay sutures in the
pericardium and diaphragm itself should
also be removed.
16b.
First gently remove any blood from the
chest cavity. Pericardial stay sutures should
also be removed if they were used.
17a. Begin at the dorsal-most aspect of the
incision and begin closing in a simple
continuous pattern using an absorbable
suture on a tapered needle. The catheter
should exit the thoracic cavity near the
ventral aspect of the incision to allow for
neutral positioning when the animal is
awake or in sternal recumbency. (
Keep in
mind that the heart has shifted dorsally
during surgical recumbency
).
17b.
Prior to closing the thorax, a 12-20
French catheter should be placed through a
stab incision caudodorasl to the main
incision and then tunneled under the skin to
enter the thorax through the intercostal
space caudal to the one through which the
thoracotomy was performed.
18a. Just prior to completing the closure of
the diaphragm, place a 8 to 10 french sterile
urinary catheter through the incision to allow
for negative pressure to be restored in the
thoracic cavity. Attach a 3-way stopcock
and 20 ml syringe to the end to withdraw the
air until you begin to feel resistance.
Remove all retraction devices from the
abdomen and check again to be sure no
additional air can be removed from the
thoracic cavity (
if air is not completely
removed the animal will have difficulty
breathing after manual ventilation is
discontinued
). If this should occur,
thoracocentesis should be performed to
remove the air as needed. Once you are
satisfied all air has been removed, the
catheter can be removed, and the remainder
18b. Multiple pieces of large absorbable
suture (~0) should be passed around the rib
in front of and behind the thoracotomy to
approximate the ribs for closure of the
thoracotomy. The assistant will pull the ribs
together to allow the surgeon to tie each
suture individually if needed.
