BLOOD TRANSFUSION

A blood transfusion is a routine medical procedure in which donated blood is provided to you through a
narrow tube placed within a vein in your arm.
This potentially life-saving procedure can help replace blood lost due to surgery or injury. A blood
transfusion also can help if an illness prevents your body from making blood or some of your blood's
components correctly.

Blood transfusions usually occur without complications. When complications do occur, they're typically
mild.

Risks
Blood transfusions are generally considered safe, but there is some risk of complications. Mild
complications and rarely severe ones can occur during the transfusion or several days or more after.
More common reactions include allergic reactions, which might cause hives and itching, and fever.
Before the procedure
In some cases, you can donate blood for yourself before elective surgery, but most transfusions involve
blood donated by strangers. An identification check will ensure you receive the correct blood.
During the procedure
An intravenous (IV) line with a needle is inserted into one of your blood vessels. The donated blood
that's been stored in a plastic bag enters your bloodstream through the IV. You'll be seated or lying
down for the procedure, which usually takes one to four hours.
A nurse will monitor you throughout the procedure and take measures of your blood pressure,
temperature and heart rate. Tell the nurse immediately if you develop:

 Fever
 Shortness of breath
 Chills
 Unusual itching
 Chest or back pain
 A sense of uneasiness
After the procedure
The needle and IV line will be removed. You might develop a bruise around the needle site, but this
should go away in a few days.
Contact your health care provider if you develop shortness of breath or chest or back pain in the days
immediately following a blood transfusion.
Results
You might need further blood testing to see how your body is responding to the donor blood and to check
your blood counts. Some conditions require more than one blood transfusion.

LUMBAR PUNCTURE
A lumbar puncture (spinal tap) is performed in your lower back, in the lumbar region. During a lumbar
puncture, a needle is inserted between two lumbar bones (vertebrae) to remove a sample of
cerebrospinal fluid. This is the fluid that surrounds your brain and spinal cord to protect them from
injury.
A lumbar puncture can help diagnose serious infections, such as meningitis; other disorders of the
central nervous system, such as Guillain-Barre syndrome and multiple sclerosis; or cancers of the brain
or spinal cord. Sometimes doctors use lumbar punctures to inject anesthetic medications or
chemotherapy drugs into the cerebrospinal fluid.

Risks
Though lumbar punctures are generally recognized as safe, they do carry some risks. These include:
 Post-lumbar puncture headache. Up to 25 percent of people who have undergone a lumbar
puncture develop a headache afterward due to a leak of fluid into nearby tissues.
The headache typically starts several hours up to two days after the procedure and may be
accompanied by nausea, vomiting and dizziness. The headaches are usually present when sitting or
standing and resolve after lying down. Post-lumbar puncture headaches can last from a few hours to
a week or more.

 Back discomfort or pain. You may feel pain or tenderness in your lower back after the
procedure. The pain might radiate down the back of your legs.
 Bleeding. Bleeding may occur near the puncture site or, rarely, into the epidural space.
 Brainstem herniation. Increased pressure within the skull (intracranial), due to a brain tumor or
other space-occupying lesion, can lead to compression of the brainstem after a sample of
cerebrospinal fluid is removed.

A computerized tomography (CT) scan or MRI prior to a lumbar puncture can be obtained to
determine if there is evidence of a space-occupying lesion that results in increased intracranial
pressure. This complication is rare.

Before the procedure

You're asked to change into a hospital gown. There are a few possible positions for this test. Usually, you
lie on your side with your knees drawn up to your chest, or you sit and lean forward on a stable surface.
These positions flex your back, widening the spaces between your vertebrae and making it easier for
your doctor to insert the needle.
For an infant or young child, someone will hold the child in position during the procedure.

Your back is washed with antiseptic soap or iodine and covered with a sterile sheet.

During the procedure

 A local anesthetic is injected into your lower back to numb the puncture site before the needle is
inserted. The local anesthetic will sting briefly as it's injected.
  A thin, hollow needle is inserted between the two lower vertebrae (lumbar region), through the
spinal membrane (dura) and into the spinal canal. You may feel pressure in your back during this
part of the procedure.
 Once the needle is in place, you may be asked to change your position slightly.
 The cerebrospinal fluid pressure is measured, a small amount of fluid is withdrawn and the
pressure is measured again. If needed, a drug or substance is injected.
 The needle is removed, and the puncture site is covered with a bandage.
After the procedure

 Plan to rest. Don't participate in strenuous activities the day of your procedure. You may return
to work if your job doesn't require you to be physically active. Discuss your activities with your
doctor if you have questions.
 Take a pain medication. A nonprescription pain-relieving medication that contains acetaminophen
can help reduce a headache or back pain.
Results
The spinal fluid samples are sent to a laboratory for analysis. Lab technicians check for a number of
things when examining spinal fluid, including:

 General appearance. Spinal fluid is normally clear and colorless. If it's cloudy, yellow or pink in
color, it might indicate abnormal bleeding. Spinal fluid that is green might indicate an infection or
the presence of bilirubin.

 Protein (total protein and the presence of certain proteins). Elevated levels of total protein —
greater than 45 milligrams per deciliter (mg/dL) — may indicate an infection or another
inflammatory condition. Specific lab values may vary from medical facility to medical facility.

 White blood cells. Spinal fluid normally contains up to 5 mononuclear leukocytes (white blood
cells) per microliter. Increased numbers may indicate an infection. Specific lab values may vary
from medical facility to medical facility.
 Sugar (glucose). A low glucose level in spinal fluid may indicate infection or another condition.
 Microorganisms. The presence of bacteria, viruses, fungi or other microorganisms can indicate an
infection.
 Cancer cells. The presence of abnormal cells in spinal fluid — such as tumor or immature blood
cells — can indicate certain types of cancer.

THORACENTESIS
also known as a pleural tap, is a procedure done when there’s too much fluid in the pleural space. This
allows a pleural fluid analysis to be performed in the lab to figure out the cause of fluid accumulation
around one or both of the lungs. The pleural space is the small space between the lungs and the chest
wall. This space typically contains approximately 4 teaspoons of fluid. Some conditions can cause more
fluid to enter this space. These conditions include:

 cancer tumors
 pneumonia or other lung infection
 congestive heart failure
 chronic lung diseases
This is called pleural effusion. If there’s excess fluid, it can compress the lungs and cause difficulty
breathing. The goal of a thoracentesis is to drain the fluid and make it easier for you to breathe again.
In some cases, the procedure will also help your doctor discover the cause of the pleural effusion. The
amount of fluid drained varies depending on the reasons for performing the procedure. It typically takes
10 to 15 minutes, but it can take longer if there’s a lot of fluid in the pleural space.

Your doctor may also perform a pleural biopsy at the same time, to get a piece of tissue from the lining
of your inner chest wall. Abnormal results on a pleural biopsy can indicate certain causes for the
effusion, including:

 the presence of cancer cells, such as lung cancer

 mesothelioma, which is an asbestos-related cancer of the tissues that cover the lungs
 collagen vascular disease
 viral or fungal diseases
 parasitic disease

Preparing for a thoracentesis
There’s no special preparation for a thoracentesis. However, you should talk to your doctor if you have
any questions or concerns about the procedure. You should also tell your doctor if you:

 are currently taking medications, including blood thinners like aspirin, clopidogrel (Plavix), or
warfarin (Coumadin)
 are allergic to any medications
 have any bleeding problems
 may be pregnant
 have lung scarring from previous procedures
 currently have any lung diseases like lung cancer or emphysema

Procedure

Thoracentesis can be done in a doctor’s office or in a hospital. It’s typically done while you’re awake, but
you may be sedated. You’ll need someone else to drive you home after the procedure if you’re sedated.
After sitting in a chair or lying on a table, you’ll be positioned in a way that allows the doctor to access
the pleural space. An ultrasound may be done to ascertain the correct area where the needle will go. The
selected area will be cleaned and injected with a numbing agent.

Your doctor will insert the needle or tube below your ribs into the pleural space. You might feel an
uncomfortable pressure during this process, but you should keep very still. The excess fluid will then be
drained out. Once all the fluid is drained, a bandage will be put on the insertion site. To ensure there are
no complications, you may be asked to stay overnight in the hospital to be monitored. A follow-up X-
ray may be performed right after the thoracentesis.
Risks
Every invasive procedure has risks, but side effects are uncommon with thoracentesis. Possible risks
include:

 pain
 bleeding
 air accumulation (pneumothorax) pushing on the lung causing a collapsed lung
 infection
Your doctor will go over the risks before the procedure.
Thoracentesis is not an appropriate procedure for everyone. Your doctor will determine if you’re a good
candidate for thoracentesis. People who’ve had recent lung surgery may have scarring, which can make
the procedure difficult.

People who should not undergo thoracentesis include people:

 with a bleeding disorder

 taking blood thinners
 with heart failure or enlargement of the heart with trapped lung

Following up after the procedure

After the procedure is over, your vitals will be monitored, and you may have an X-ray of your lungs
taken. Your doctor will allow you to go home if your breathing rate, oxygen saturation, blood pressure,
and pulse are all good. Most people who have a thoracentesis can go home the same day. You’ll be able to
return to most of your normal activities soon after the procedure. However, your doctor may recommend
that you avoid physical activity for several days after the procedure.
Your doctor will explain how to take care of the puncture site. Make sure to call your doctor if you begin
to have any signs of infection. Symptoms of infection include:
 trouble breathing
 coughing up blood
 fever or chills
 pain when you take deep breaths
 redness, pain, or bleeding around the needle site

DRAINAGE SYSTEM (PNEUMOTHORAX)

A chest tube can help drain air, blood, or fluid from the space surrounding your lungs, called the pleural
space.

Chest tube insertion is also referred to as chest tube thoracostomy. It’s typically an emergency
procedure. It may also be done after surgery on organs or tissues in your chest cavity. During chest tube
insertion, a hollow plastic tube is inserted between your ribs into the pleural space. The tube may be
connected to a machine to help with the drainage. The tube will stay in place until the fluid, blood, or air
is drained from your chest.

What it’s used for

You may need a chest tube if you have any of the following:
 a collapsed lung
 a lung infection
 bleeding around your lung, especially after a trauma (such as a car accident)
 fluid buildup due to another medical condition, such as cancer or pneumonia
 breathing difficulty due to a buildup of fluid or air
 surgery, especially lung, heart, or esophageal surgery
Inserting a chest tube may also help your doctor diagnose other conditions, such as lung damage or
internal injuries after a trauma.

How to prepare
Chest tube insertion is most commonly performed after surgery or as an emergency procedure, so
there’s usually no way for you to prepare for it. Your doctor will ask for your consent to perform the
procedure if you’re conscious. If you’re unconscious, they’ll explain why a chest tube was necessary after
you wake up. In cases where it isn’t an emergency, your doctor will order a chest X-ray before chest
tube insertion. This is done to help confirm whether fluid or air buildup is causing the problem and to
determine if a chest tube is needed. Some other tests may also be done to evaluate pleural fluid, such as
a chest ultrasound or chest CT scan.

Procedure

Someone who specializes in lung conditions and diseases is called a pulmonary specialist. A surgeon or
pulmonary specialist will usually perform the chest tube insertion. During chest tube insertion, the
following happens:
Preparation: Your doctor will prepare a large area on the side of your chest, from your armpit down to
your abdomen and across to your nipple. Preparation involves sterilizing the area and shaving any hair
from the insertion site, if necessary. Your doctor may use an ultrasound to identify a good location for
inserting the tube.
Anesthesia: The doctor may inject an anesthetic into your skin or vein to numb the area. The medication
will help make you more comfortable during the chest tube insertion, which can be painful. If you’re
having major heart or lung surgery, you’ll likely be given general anesthesia and be put to sleep before
the chest tube is inserted.
Incision: Using a scalpel, your doctor will make a small (¼- to 1 ½-inch) incision between your ribs, near
the upper part of your chest. Where they make the incision depends on the reason for the chest tube.
Insertion: Your doctor will then gently open a space into your chest cavity and guide the tube into your
chest. Chest tubes come in various sizes for different conditions. Your doctor will stitch the chest tube
in place to prevent it from moving. A sterile bandage will be applied over the insertion site.
Drainage: The tube is then attached to a special one-way drainage system that allows air or fluid to flow
out only. This prevents the fluid or air from flowing back into the chest cavity. While the chest tube is
in, you’ll probably need to stay in the hospital. A doctor or nurse will monitor your breathing and check
for possible air leaks.
How long the chest tube is left in depends on the condition that caused the buildup of air or fluid. Some
lung cancers can cause fluid to reaccumulate. Doctors may leave the tubes in for a longer period of time
in these cases.

Complications

Chest tube insertion puts you at risk of several complications. These include:

Pain during placement: Chest tube insertion is usually very painful. Your doctor will help manage your
pain by injecting an anesthetic through an IV or directly into the chest tube site. You’ll be given either
general anesthesia, which puts you to sleep, or local anesthesia, which numbs the area.

Infection: As with any invasive procedure, there’s a risk of infection. The use of sterile tools during the
procedure helps reduce this risk.
Bleeding: A very small amount of bleeding can occur if a blood vessel is damaged when the chest tube is
inserted.
Poor tube placement: In some cases, the chest tube can be placed too far inside or not far enough
inside the pleural space. The tube may also fall out.
Serious complications
Serious complications are rare, but they can include:
 bleeding into the pleural space
 injury to the lung, diaphragm, or stomach

 collapsed lung during tube removal

Removing the chest tube

The chest tube usually stays in for a few days. After your doctor is sure that no more fluid or air needs
to be drained, the chest tube will be removed. The removal of the chest tube is usually performed
quickly and without sedation. Your doctor will give you specific instructions on how to breathe when the
tube is removed. In most cases, the chest tube will be removed as you’re holding your breath. This
ensures extra air doesn’t get into your lungs. After the doctor removes the chest tube, they’ll apply a
bandage over the insertion site. You may have a small scar. Your doctor will likely schedule an X-ray at a
later date to make sure that there isn’t another buildup of air or fluid inside your chest.

TRACHEOSTOMY

A tracheostomy is a medical procedure — either temporary or permanent — that involves creating an

opening in the neck in order to place a tube into a person’s windpipe. The tube is inserted through a cut
in the neck below the vocal cords. This allows air to enter the lungs. Breathing is then done through the
tube, bypassing the mouth, nose, and throat. A tracheostomy is commonly referred to as a stoma. This is
the name for the hole in the neck that the tube passes through.

Why a tracheostomy is performed

A tracheostomy is performed for several reasons, all involving restricted airways. It may be done during
an emergency when your airway is blocked. Or it could be used when a disease or other problem makes
normal breathing impossible.

Conditions that may require a tracheostomy include:

 anaphylaxis
 birth defects of the airway
 burns of the airway from inhalation of corrosive material
 cancer in the neck
 chronic lung disease

 coma
 diaphragm dysfunction
 facial burns or surgery
 infection
 injury to the larynx or laryngectomy
 injury to the chest wall
 need for prolonged respiratory or ventilator support
 obstruction of the airway by a foreign body
 obstructive sleep apnea
 paralysis of the muscles used in swallowing
 severe neck or mouth injuries
 tumors
 vocal cord paralysis
How to prepare for a tracheostomy
If your tracheostomy is planned, your doctor will tell you how to prepare for the procedure. This may
involve fasting for up to 12 hours before the procedure. If your tracheostomy is performed during an
emergency, there will be no time to prepare.

How a tracheostomy is performed

For most scheduled tracheostomies, you’ll be given general anesthesia. This means you’ll fall asleep and
won’t feel any pain. In emergencies, you’ll be injected with local anesthesia. This numbs the area of your
neck where the hole is made. The procedure will begin only after the anesthesia has started working.

Your surgeon will make a cut into your neck just below your Adam’s apple. The cut will go through the
cartilaginous rings of the outer wall of your trachea, also known as your windpipe. The hole is then
opened wide enough to fit a tracheostomy tube inside. Your doctor may hook up the tube to a ventilator,
in case you need a machine to breathe for you. The tube will be secured in place with a band that goes
around your neck. This helps keep the tube in place while the skin around it heals. Your surgical team will
tell you how to care for the wound and your tracheostomy tube.

Adapting to a tracheostomy tube

It typically takes one to three days to adapt to breathing through a tracheostomy tube. Talking and
making sounds also takes some practice. This is because the air you breathe no longer passes through
your voice box. For some people, covering the tube helps them talk.

Alternately, special valves can be attached to the tracheostomy tube. While still taking in air through
the tube, these valves allow air to exit the mouth and nose, permitting speech.

The risks of a tracheostomy

Every medical procedure where the skin is broken carries the risk of infection and excessive bleeding.
There’s also a chance of an allergic reaction to anesthesia, although it’s rare. Tell your doctor if you’ve
had an allergic reaction to anesthesia in the past.

Risks specific to a tracheostomy include:

 damage to the thyroid gland in the neck
 erosion of the trachea, which is rare
 lung collapse
 scar tissue in the trachea

Outlook after a tracheostomy

If your tracheostomy is temporary, there’s typically only a small scar left when the tube is removed.
Those with a permanent tracheostomy may need assistance to get used to the stoma. Your doctor will
give you tips about cleaning and maintaining the tube. Though people with tracheostomies have initial
difficulty speaking, most can adjust and learn to speak.