Pleural Aspiration

Indications:

For diagnostic and therapeutic reasons

Collapse of the underlying lung secondary to pleural collections of air or fluid

Position:

Upright in bed or astride a chair leaning forward, with the arm on the proposed site of insertion
held across.

Anesthesia:

L/A (10 ml of 1% lignocaine)

The pleural punctures will be made in the first instance on the 8th or 9th inter costal space

on the posterior axillary line. The site of puncture is infiltrated with 2% local anaesthetic

solution. A large needle or spinal needle along the superior border of the inferior rib(avoiding the
neurovascular bundle on the inferior border of the superior rib) is introduced and as much fluid
as possible should be aspirated. Drainage of loculated effusion may require more than puncture
and large effusion should be evacuated gradually through basal chest drain which is clamped
intermittently to avoid producing respiratory distress.

After aspiration, dressing will be done with povidone iodine at the site of aspiration.

Complications:

Injury to diaphragm, liver and spleen

BARRON’S BANDING

Indications:

Grade 2 Haemorrhoids with pedicles

• After cleaning and draping each Haemorrhoid is visualized through proctoscope

• The upper part of mucocutaneous line is grasped by an instrument (Barrons gun) and
small elastic band slipped over it.

• Recent modification uses a modified proctoscope with bands stretched over the inner
drum and pushed off by advancing the outer drum of proctoscope over it.

• Care must be taken to insert the band so that it occludes the base of hemorrhoid at least
1cm above the dentate line. If the dentate line included in ligated band considerable pain will
result.

• 2 bands simultaneously inserted over each haemorrhoids as this reduces the risks of
secondary hemorrhage.

• The ligated haemorrhoid will necroses in 24 to 48 hrs and slough off in about 7 days.

BIOPSY OF ULCER

After part preparation and administration of local anaesthesia a non healing ulcer of long
duration will be cleaned with savlon and betadine solution.

Small bits of tissue from margin of ulcer (usually 4 quadrants) collected with cutting

scissors and forceps. This specimen will be sent for histo-pathological examination.

Complete haemostasis will be maintained and after that dressing with sofra-tulle will be
done. After 2 hours observation patient will be discharged.