Chest Tubes PDF

Chest Tubes  Pneumothorax  Caused by air entering pleural cavity.  Positive pressure in cavity causes lung to collapse.  Can be open or closed.  Pneumothorax  Clinical manifestations  Variable  Mild tachycardia and dyspnea → severe re...

Chest Tubes  Pneumothorax  Caused by air entering pleural cavity.  Positive pressure in cavity causes lung to collapse.  Can be open or closed.  Pneumothorax  Clinical manifestations  Variable  Mild tachycardia and dyspnea → severe respiratory distress  Chest pain  Cough  Absent breath sounds over affected area  Pneumothorax  Types  Iatrogenic  Caused by medical procedures  Example: Central line insertion, Thoracentesis  Traumatic penetrating (open)  Can cause a sucking chest wound.  Apply “vent” dressing.  On inspiration dressing seals wound, preventing air entry  On expiration allows trapped air to escape through untapped edge  Do not remove impaled object.  Traumatic blunt (closed)  Lung laceration  Alveolar rupture  Pneumothorax  Types  Tension Pneumothorax  Accumulation of air in pleural space that does not escape  Causes mediastinal shift and hemodynamic instability.  Can occur with open or closed pneumothorax. Collaborative Care Pneumothorax  Dependent on severity  May resolve spontaneously  Treatment  Thoracentesis—smaller amounts of air/fluid and or no ongoing potential issues  Chest tubes  Urgent needle decompression for tension pneumothorax  Chest Trauma  Hemothorax  Blood in pleural space  Treat with chest tube  Hemopneumothorax  Blood and air in the pleural space  Treat with chest tube  Chest Trauma Emergency Management  Assess for signs of respiratory distress.  Dyspnea  Cough with or without hemoptysis  Cyanosis  Tracheal deviation-tension pneumothorax sign  Decreased breath sounds  Decreased O2 saturation  Frothy secretions Chest Tube: Dry suction Chest drainage unit. This unit has 3 chambers: (1) collection chamber; (2) water-seal chamber; and (3) suction control chamber. Suction control chamber requires a connection to a wall suction source that is dialed up higher than the prescribed suction for the suction to work. In the dry suction unit the wall suction is controlled by using a regulator control dial. (From Atrium Medical Corporation, Hudson, N.H.) Copyright © 2017, Elsevier Inc. All Rights Reserved.  Chest Tube: Dry suction  Please watch video: Chest Tube Site, Wet & Dry Drainage System Assessment Demonstration  https://www.youtube.com/watch?v=BC1cjogkWQs  Copy link and paste it into YouTube search bar to see video Chest Tube: Water suction Copyright © 2017, Elsevier Inc. All Rights Reserved. Chest drainage unit. This unit has 3 chambers: (1) collection chamber; (2) water-seal chamber; and (3) suction control chamber. Suction control chamber requires a connection to a wall suction source that is dialed up higher than the prescribed suction for the suction to work. In the water suction unit, the suction control chamber controls the wall suction pressure. (From Atrium Medical Corporation, Hudson, N.H.) Chest Tube: Water suction  Please watch video  https://www.youtube.com/watch?v=BC1cjogkWQs Chest Tubes and Pleural Drainage  To remove air or fluid from pleural and/or mediastinal space  Reestablishes negative pressure  Lung reexpands  Pleural and/or mediastinal  20 inches long  Various sizes (12F – 40F) spring 2017  Nursing Management  Maintain patency of drainage system.  Keep tubing loosely coiled.  Tape connections.  Observe tidaling (normal fluctuation in the water seal chamber— up and down—with inspiration/expiration).  Observe for air leak (continuous bubbling in water-seal chamber —the 2nd compartment that acts as a one-way valve).  Suction control chamber (3rd compartment) applies suction to the chest drainage system—intermittent bubbling here is expected  Nursing Management  Review patient’s medication record for anticoagulation therapy including aspirin, warfarin, and heparin  Review for allergies (especially Latex)  Assess patient’s clinical status.  Vital signs, lung sounds, pain  Drainage amount in collection chamber (1st compartment)  Assess for drainage site infection  Subcutaneous emphysema—NOT crepitus  Encourage deep breathing, range-of-motion exercises, incentive spirometry.  Monitor for complications.  Subcutaneous emphysema  Dressing care  Sterile occlusive dressing and petroleum gauze around the insertion site to prevent air leak  At bedside—new dressing, clamps  Nursing Management  Do not elevate system above chest.  Change container when full.  Measure fluid level.  Report > 100mL/hr.