CPT® Code 32960

1. Indications

The therapeutic pneumothorax procedure is indicated for specific conditions related to pulmonary tuberculosis and other related pulmonary issues. The following are the primary indications for performing this procedure:

• Pulmonary Tuberculosis - This procedure is primarily performed to treat pulmonary tuberculosis, where the collapse of the lung can help in the healing process.
• Severe Lung Conditions - It may also be indicated in cases of severe lung conditions where therapeutic collapse is deemed necessary to alleviate symptoms or facilitate treatment.

2. Procedure

The procedure for creating a therapeutic pneumothorax involves several critical steps that ensure the safe and effective introduction of air into the pleural space. Each step is essential for achieving the desired therapeutic outcome.

• Step 1: Preparation - The patient is positioned appropriately, typically in a sitting or semi-reclined position, to facilitate access to the chest. Sterile techniques are employed to minimize the risk of infection, and local anesthesia may be administered to ensure patient comfort during the procedure.
• Step 2: Incision - A small intercostal incision is made between the ribs, which allows access to the intercostal space. This incision is carefully placed to avoid damaging surrounding structures, such as blood vessels and nerves.
• Step 3: Insertion of Trocar - A trocar, which is a sharp, pointed instrument, is inserted through the intercostal incision and advanced into the pleural space. This step requires precision to ensure that the trocar enters the pleural cavity without causing injury to the lung or other thoracic structures.
• Step 4: Injection of Air - Once the trocar is correctly positioned in the pleural space, air is injected through the trocar. The amount of air injected is carefully controlled to achieve the desired level of lung collapse, which is necessary for the therapeutic effect.
• Step 5: Monitoring - After the air injection, the patient is monitored for any immediate complications, such as respiratory distress or changes in vital signs. The effectiveness of the procedure is assessed, and further interventions may be considered if the lung does not collapse adequately.

3. Post-Procedure

Post-procedure care is crucial to ensure patient safety and monitor for any complications. After the therapeutic pneumothorax is created, the patient is typically observed in a clinical setting for a period of time. Monitoring includes checking vital signs, assessing respiratory function, and ensuring that there are no signs of pneumothorax-related complications, such as tension pneumothorax or infection. Patients may experience some discomfort at the incision site, which can be managed with appropriate analgesics. Follow-up imaging studies, such as chest X-rays, may be performed to evaluate the extent of lung collapse and to determine if further intervention is necessary. If the lung does not collapse as intended, additional procedures, such as lysing intrapleural adhesions, may be required to achieve the desired therapeutic effect.