CONTRIBUTOR(S): Hayleigh Green, Claire Speight,
Chest drains – uses and placement
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A chest drain is where a veterinary surgeon places a tube under anesthesia into the thoracic (chest) cavity to remove air or fluid. This drain then remains in place to prevent the air and/or fluid returning.
This is a very rare procedure in rabbits and the risks should be discussed in depth with your veterinary surgeon.
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Why does my rabbit need a chest drain?
Chest drains are used to remove and prevent fluid/air within the thoracic (chest) cavity.
Fluid/air can accumulate in the chest for a range of reasons, often it is caused by a disease such as cardiac (heart) disease, or it can also be caused by infection, trauma, or be required after surgery within the chest cavity, such as surgical removal of a thymoma.
What does the procedure involve?
Chest drains are placed under a general anesthetic. The veterinary surgeon will induce anesthesia with a veterinary nurse or anesthetist closely monitoring your rabbit’s heart rate, respiration rate, blood pressure, carbon dioxide levels, oxygen saturation, mucous membrane color, eye position and capillary refill time. All of these parameters are important to monitor to help ensure the anesthetic is as safe as possible.
Once under anesthesia your rabbit’s fur will be clipped from their chest using pet clippers, and the area will be cleaned with a surgical scrub to reduce the risk of infection. Local anesthesia is injected into the skin to ensure they remain pain free during and after the procedure. The surgeon will then make a skin incision to place the tip of the chest drain under the skin. The drain will then be guided by the surgeon, avoiding vital organs, to sit in the correct position within the chest. A port will be attached to the drain and any fluid/air will then be removed. The drain will be secured to the rabbit’s skin using sutures, and a bandage will be placed over the wound.
X-rays may be taken to confirm correct positioning, and that the drainage is adequate. The nurse or anesthetist will monitor your rabbit closely during the procedure and afterwards during their recovery from the anesthetic.
What are the associated risks?
Chest drains are placed under a general anesthesia. Anesthetics are carried out within veterinary practices every day, however any procedure involving the thoracic cavity is a higher risk. Rabbits also have a higher risk of anesthetic complications than a cat or dog, this is due to their anatomy, physiological reaction to stress, and that rabbits less frequently undergo the procedure. If your vet does not feel able to place the chest drain, they may refer your rabbit to an exotics vet with more experience in the procedure.
The risk of anesthesia for this procedure should be discussed with your veterinary surgeon before the procedure goes ahead. There is a significant risk of death with this procedure.
What will my rabbit need after the operation?
Your rabbit will need to stay at the veterinary practice after the operation where the veterinary team will monitor the volume of air/fluid being removed from their chest and their vital parameters. The bandage over the drain will be changed at least daily, and it is important your rabbit doesn’t chew the wound or drain.
Elizabethan collars generally are not needed in rabbits, but additional bandage coverings may be needed to prevent your rabbit from interfering with the wound. Pain relief and antibiotics may also be given to keep your rabbit comfortable and infection free, and prokinetic medications are often required to help keep the gastrointestinal tract moving, along with supportive feeding and fluid therapy.
When and how will the drain be removed?
The chest drain will be removed once the veterinary surgeon feels your rabbit is well enough to no longer need the drain in place. This does not mean the fluid/air won’t return and their condition may need to be medically managed instead.
To remove the drain, your rabbit will be carefully restrained by a member of the veterinary team whilst another uses a specific scalpel blade to cut through the suture and gently remove the drain. The suture is a special suture that ensures the wound is held closed at this point.
My veterinarian mentioned thoracocentesis instead. What is this?
This is a procedure where a needle is placed in the chest cavity, usually a butterfly needle which allows a syringe to be attached to the tubing at the end of the butterfly catheter, and the fluid to be manually drained. This can be done conscious in some pets but in rabbits, where they are likely to jump or resist restraint, they may require a sedative or general anesthetic to allow the procedure to be undertaken safely.
Thoracocentesis can help relieve the pressure on the chest, but it does not prevent future build up or remain in place. Due to the fact this procedure is done via a needle, it is unlikely all the fluid will be removed as often it can form in ‘pockets’. Performing the procedure using ultrasound to guide the needle makes it safer and easier to remove as much of the fluid as possible.
What else do I need to know?
Rabbits become stressed easily. Management of stress and pain is just as important as managing their health condition. Stasis/ileus (when the digestive system slows down and can stop entirely) is a serious condition in rabbits, and should be treated as an emergency, so if your rabbit stops eating before or after their surgery, contact your veterinary surgeon immediately.