Chest Tubes & Congenital Heart Defects PDF

CHEST TUBES The purpose for chest tubes is to re-establish negative pressure (negative pressure makes things stick together) in the pleural space. They are used for lobectomy and wedge resections Pneumothorax → removes air ( air = positive pressure pushes things away) Hemothorax → remo...

CHEST TUBES The purpose for chest tubes is to re-establish negative pressure (negative pressure makes things stick together) in the pleural space. They are used for lobectomy and wedge resections Pneumothorax → removes air ( air = positive pressure pushes things away) Hemothorax → removes blood (blood = positive pressure pushes things away) Pneumohemothorax → removes air and blood (air & blood = positive pressure) LOCATION of the tube: APICAL ( high for a ir) ○ Label “A” → up high, apex/top of lung BASILAR ( bottom for b lood) ○ Label “B” → placed at base/bottom of lung Examples: How many chest tubes (and where) for unilateral pneumohemothorax? ○ 2 ⇒ apical and basilar all on the side of the pneumothorax How many chest tubes (and where) for bilateral pneumothorax? ○ 2 ⇒ apical on right and left sides How many chest tubes (and where) for post-op chest surgery? ○ 2 ⇒ apical and basilar on the side of the surgery ○ Exception: If surgery total pneumonectomy then → no chest tube because no pleural space ○ Always assume chest trauma and surgery is unilateral, unless otherwise specified **Only clamp chest tube in an emergency  Water Seal Chest Tube Dry Seal Chest Tube TROUBLESHOOTING: What do you do if you kick over the collection bottle? ○ Not a big deal; can just sit it right back up; have take a couple deep breaths What do you do if the water seal breaks? ○ This is more serious, because it is allowing air in creating a 2 way ○ First: Clamp chest tube then cut tube away from broken device **In routine care never clamp chest tube!!** ○ Best: Submerge the tube under sterile water , then unclamp it because you have re-established the water seal. It is better for the tube to be under water than to be clamped because underwater → air can’t go in, but stuff can come out. If it is clamped, nothing can go in or out. ○ Order → Clamp, Cut, Submerge, Unclamp What do you do if the chest tube comes out/gets pulled out? ○ First: cover hole with gloved hand ○ Best: cover it with vaseline gauze; put a dry sterile dressing on top and tape it on 3 sides **NCLEX TIP : KNOW FIRST vs BEST... Example: Patient is in V-Fib on the monitor.. BAD, you run to the room and they are unresponsive with no pulse! FIRST thing you should do → place backboard.. BEST thing to do → chest compressions FIRST questions is asking about order BEST questions is asking if you could only do one thing , what would be the best thing to do is? Bubbling ○ Ask yourself two questions: WHERE is it bubbling  WHEN is it bubbling ○ Sometimes bubbling is good & sometimes it’s bad - depends on where & when! Where? Water seal.. When? Intermittent = GOOD! Document that! Where? Water seal... When ? Continuous = BAD! ⇒ LEAK... You do not want continuous bubbling in the water seal. Find the leak and tape it until it stops leaking Where? Suction control chamber.. When ? Intermittent = BAD... Suction is not high enough, turn up suction on the wall Where? Suction control chamber.. When ? Continuous = GOOD.. Document that! ○ *If something is sealed, should you have a continuous bubbling? NO. ○ Straight cath is to a foley catheter as a thoracentesis is to a chest tube.. Rules for clamping a tube: Do NOT clamp longer than 15 seconds without a doctor’s order... What happens if you break the water seal? CLAMP it! How long do you have to get it under water? 15 seconds, or you gotta unclamp.. ○ Have sterile water bottles nearby! Use rubber tip double clamps... Rubber so you do not puncture the tube CONGENITAL HEART DEFECTS Every congenital heart defect is either TROUBLE or NO TROUBLE (no in between) TRouBLe T → All CHD’s begin with “T ” are trouble; exception → Left ventricular hyperplasic syndrome R - L → Blood shunts B → Cyanotic Trouble defect shunts blood: RIGHT to LEFT (cyanotic, blue); needs surgery, delayed growth, decreased life expectancy, needs more time in the hospital/pediatric cardiologist NO-trouble defect shunts blood: LEFT to RIGHT (acyanotic, pink); doesn’t need surgery, normal growth, normal life expectancy, only 24-36 hours in the hospital/pediatrician/NP.. 40 some congenital heart defects..  Examples of “TROUBLE” Heart Defects RIGHT Examples of “NO TROUBLE” Heart Defects LEFT to LEFT → Blue to RIGHT → Pink Tetralogy of Fallot, Truncus Arteriosus, Transposition on Ventricular Septal Defect, Patent Ductus Arteriosus, Patent Foramen Ovale, Atrial Septal Defect, Pulmonic the great vessels, Transposition on the great arteries, Tricuspid atresia, Total anomalous pulmonary venous Stenosis return (TAPV), Left Ventricular Hyperplastic Syndrome ALL congenital heart defect kids (whether trouble or not) will have 2 things in common: They will all have a murmur ( because the shunt of the blood) They will all have an ECHO done **4 defects of tetralogy of fallot: Varie D ⇒ VD (ventricular defect) Picture S ⇒ PS (pulmonary stenosis) Of A ⇒ OA (overriding aorta) Ranc H ⇒ RH (right hypertrophy)