Nursing Care for Patients with Central Lines & Chest Tubes PDF

Nursing Care for Patients with Central Lines & Chest Tubes & Principles of Emergency Care Airway Obstruction Prepared by Suzanne Badawi Nursing Care for Patients with Chest Tubes ① A chest tube is a plastic tube that is used to drain fluid or air from the ch...

Nursing Care for Patients with Central Lines & Chest Tubes & Principles of Emergency Care Airway Obstruction Prepared by Suzanne Badawi Nursing Care for Patients with Chest Tubes ① A chest tube is a plastic tube that is used to drain fluid or air from the chest. Pneumothorax: A pneumothorax is a collection of air outside the lung but within the pleural cavity. It occurs when air accumulates between the parietal and visceral pleura inside the chest Tension pneumothorax: One way valve effect which allows air to enter the pleural space, but not leave. It is a severe condition that results when air is trapped in the pleural space under positive pressure, displacing mediastinal structures and compromising cardiopulmonary function. Hemothorax: Hemothorax is a serious condition in which blood collects in the pleural space. Chylothorax: Chylothorax is a rare but serious condition in which lymph formed in the digestive system (chyle) accumulates in the chest cavity. Lymph is a fluid containing white blood cells and proteins that moves through the lymphatic system and drains into the bloodstream. Pleural effusion: A pleural effusion is a buildup of fluid between the layers of tissue that line the lungs and chest cavity Nursing Care for Patients with Chest Tubes Nursing Care for Patients with Chest Tubes Indications for chest tube placement include: pneumothorax penetrating chest trauma severe blunt chest trauma Hemothorax Chylothorax symptomatic pleural effusion postoperative use in thoracic Nursing Care for Patients with Chest Tubes Chest Drain Set Up: Perform hand hygiene Prepare equipment and drain as per manufacturer instructions Open drain packing in an aseptic manner “no touch” The chest tube is inserted through a 1-inch (2.5 cm) cut the skin between ribs. Then it is guided to the correct spot Clean the skin with an antiseptic solution such as chlorhexidine to kill any bacteria and a local anesthetic is then injected to numb the area where the tube is to be inserted A small cut is then made in the anaesthetized area and the doctor gently opens up a path for the chest drain. Insert the tube at the fourth (or fifth) intercostal space as the basis for siting a 'good hole’, in the mid- axillary or anterior axillary line Nursing Care for Patients with Chest Tubes Apply suction to drain if ordered Secure drain and tubing and patient Secure all connections with cable ties Perform hand hygiene The evidence from studies conducted with adults suggests that routine stripping or milking of chest tubes is unnecessary and may potentially cause harm by tissue entrapment.  Nursing Care for Patients with Chest Tubes Equipment Chest drainage bottles (see below) Adequate length (1.5-2 m) of sterile, transparent, plastic tubing (eg, vinyl or Silastic) Appropriate sterile connectors. Adhesive tape. Angled clamps (2) for clamping the tube when needed. Distilled water to fill in the drainage bottle. Thoracostomy is a minimally invasive procedure in which a doctor inserts a thin plastic tube into the pleural space Nursing Care for Patients with Chest Tubes Chest drain management: Once the chest tube is in place, verified by x-ray, and attached to a drainage device Nursing care for patients with a chest tube includes: _ assessment of the chest tube site to prevent dislodgement and infection _ management of effective suction and drainage _ assess pain and administer regular pain relief (because the parietal pleura is very sensitive) _ monitor the respiratory status _ provide overall supportive care. _ Mark the time and fluid level on the side of the drainage chamber. When caring for this tube, what should the nurse do? Raise the drainage system to bed level and check its patency. Clamp the tube when moving the client from the bed to a chair. Nursing Care for Patients with Chest Tubes Make sure that patient don't lie on the chest tube and make sure it's not kinked or being pulled. Keep the collection container upright and below the chest. Nurse will help patient to a sitting position to help promote drainage into the collection device. Nursing care should include ongoing monitoring of patient's vital signs and medical apparatus output monitoring Patients are often initially monitored in the ICU after thoracostomy placement. In those patients, oxygen saturation levels should be monitored at a minimum of every two hours and preferably continuously. Drain output should be monitored no less than every 8 hours. Chest drain should not be clamped unless ordered by medical staff, There is a risk of developing a tension pneumothorax Never lift drain above chest level Nursing Care for Patients with Chest Tubes Ensure all connections between chest tubes and drainage unit are tight and secure Ensure the water seal is maintained at 2cm at all times Tubbing should be anchored to the patient skin to prevent pulling of the drain If suction is required order should be written by medical staff Air leak (bubbling): _an air leak should be characterized by intermittent bubbling in the water seal chamber when the patient with a pneumothorax exhales or coughs _ Continuous bubbling of this chamber indicates large air leak between the drain and the patient. Oscillation: water in the water seal chamber will rise and fall with respiration, watch for unexpected cessation of swing as this may indicate the tube is blocked or kinked. Nursing Care for Patients with Central Line ② A central line (or central venous catheter) is like an intravenous line. But it is much longer than a regular IV and goes all the way up to a vein near the heart or just inside the heart. A patient can get medicine, fluids, blood, or nutrition through a central line. It’s a tube inserted by the physician place in a large vein There are three main access sites for the placement of central venous catheters: internal jugular common femoral subclavian veins. These are the preferred sites for temporary prominent venous catheter placement Nursing Care for Patients with Central Line There are many indications for central venous catheterization: Inadequate peripheral venous access (antibiotherapy, chemotherapy…) Central venous pressure monitoring Infusion of hyperosmolar or sclerosing substances (blood transfusion, IV alimentation…) Hemodialysis. Help conduct certain medical tests Nursing Care for Patients with Central Line The Seldinger technique is the most common method used when placing a central intravenous (IV) line. The Seldinger technique can be used when placing central IV lines in the following locations: Internal jugular vein. Subclavian vein. Procedure for central line insertion: Wash hands and put sterile gown and gloves. Clean the area and apply sterile field.... Apply sterile sheath to the ultrasound probe. Confirm anatomy. Under ultrasound guidance insert lignocaine cutaneously, subcutaneously and around internal jugular. The Seldinger technique is particularly useful for the access of central vessels that run deeper into the extremity Nursing Care for Patients with Central Line Complications of venous central line: The vascular complications seen during a central line insertion are arterial injury, venous injury, bleeding, and hematoma formation. Ultrasound guidance has been shown to greatly reduce the risk of vascular complications. Different kinds of central venous catheters: Long venous catheters (single lumen or multilumen) Swan Ganz catheter (right heart catheterization):is the passing of a thin catheter into the right side of the heart and the arteries leading to the lungs. It is done to monitor the heart's function and blood flow and pressures in and around the heart. Catheters used in dialysis Implanted ports Nursing Care for Patients with Central Line Implanted ports Catheters used in dialysis Nursing Care for Patients with Central Line Potential complications of a Central Line? Central Line-Associated Bloodstream Infection (CLABSI)... Collapsed Lung (Pneumothorax)... Delayed Pneumothorax (after 24 hours)... Artery Puncture.... Nerve or Vein injury.... Blood Clot (Thrombus)... Air Bubble in the Blood (Air Embolism)... Irregular Heartbeat. Catheter central line dislocation Subcutaneous hematoma, hemothorax Nursing Care for Patients with Central Line An arterial catheter used for: Intra-arterial catheters are often inserted for invasive blood pressure (BP) monitoring and intravascular access for blood sampling in high-risk surgical and critically ill patients. The management for central catheters revolves around preventing catheter-based skin site or blood infections, central line thrombosis and mechanical complications. Catheter maintenance should involve using aseptic techniques when handling or manipulating catheters. The most common complication while inserting a catheter is air embolism, to prevent this accident, place the patient in Trendelenburg position ( supine with pelvis higher than shoulders) Nursing Care for Patients with Central Line Post Catheter placement: Ports flushed with saline or sterile water Catheter secured with sutures Cover with sterile dressing (tegaderm) Obtain chest X-Ray once finishing the procedure Change the dressing and catheter parts as protocol (every 7days) Nursing Care for Patients with Central Line Dressing of central line: Perform hand hygiene (done during pre-procedure). Apply sterile gloves Apply a mask and clean gloves. Instruct client to turn head away from site, or place mask on client. Remove old dressing and discard. Remove stabilization device or steri-strips, being careful not to dislodge catheter. Inspect catheter, site, and surrounding skin. Measure external PICC length and compare to baseline. Clean site and tubing with chlorhexidine and allow to dry Apply new catheter stabilization device or steri-strips. Apply sterile transparent semipermeable dressing over insertion site Remove and discard gloves. Perform hand hygiene. Date, time, initial and attach label to dressing.