b. Transillumination (12)

c. Radiograph (7,21)

2. Provide ventilatory support as needed. Majority of

infants with a pneumothorax requiring chest tube also

need mechanical ventilatory support.

3. Monitor vital signs. Move any electrodes from the operative site to alternative monitoring areas.

4. Position infant with affected side elevated 60 to

75 degrees off the bed, and support the back with a

Fig. 38.7. Anterior versus posterior position of the

tube for drainage of air or fluid. Because air collects

anteromedially in the supine neonate, the posterior tip

is less appropriate.

C

A B

Fig. 38.6. A: Anteroposterior radiograph demonstrates ventral air over the hemidiaphragms and around

the heart (arrowheads). The sometimes difficult question of pneumothorax versus pneumomediastinum is

answered by the decubitus films. B: The left lateral

decubitus radiograph (right side up) shows that the

right-sided gas is a pneumothorax (arrowheads). C: The

right decubitus film indicates that the adventitial air fails

to come up over the lung and is located in the mediastinum (arrowheads). This important distinction is made

obvious by the decubitus radiographs.

Chapter 38 ■ Thoracostomy 261

C

A

B

Fig. 38.8. Sequential radiographs in a patient with right pneumothorax. An air collection in supine neonates (A) is most effectively

treated with an anteromedial chest tube (B, C). The medial extension is falsely exaggerated by the slight right posterior oblique rotation of the chest. Pulling this tube back might put the side holes

outside the pleural space. There is a pneumomediastinum, most evident on the lateral view, not drained by the pleural tube. Note the

nuchal air on all three films.

Fig. 38.9. A: Photograph of a pigtail catheter placed posteriorly for

pleural fluid drainage. B: Serosanguineous pleural fluid collection

into the chest tube set.

A

B