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Chest Tubes

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http://www.medicalive.net/186_chest_tube_insertion If time permits http://www.atriummed.com/Products/Chest_Drains/edu-ocean.asp Oasis dry suction set up http ://www ... – PowerPoint PPT presentation

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Title: Chest Tubes


1
Chest Tubes
  • by Charlotte Cooper RN, MSN, CNS
  • modified by Kelle Howard RN, MSN
  • Modified by Darlene Cookie Wilson, RN, MSN

2
Thoracic Cavity
  • Lungs
  • Mediastinum
  • Heart
  • Aorta and great vessels
  • Esophagus
  • Trachea

3
Breathing Inspiration
  • Diaphragm contracts
  • Moves down
  • Increasing the volume of the thoracic cavity
  • When the volume increases, the pressure inside
    ________.
  • aka?
  • Pressure within the lungs is called
    intrapulmonary pressure

4
Breathing Exhalation
  • Phrenic nerve stimulus stops
  • Diaphragm relaxes
  • This ______ the volume of the thoracic cavity
  • Lung volume decreases, intrapulmonary pressure
    _____

5
Physics of Gases
  • If two areas of different pressure communicate,
    gas will move from the area of higher pressure to
    the area of lower pressure

6
Pleural Anatomy
  • Parietal pleura
  • lines the chest wall
  • Visceral pleura (pulmonary)
  • covers the lung

7
Pleural Anatomy
Parietal pleura
Visceral pleura
Lung
Ribs
Intercostal muscles
Normal Pleural Fluid Quantity Approx. 10-20 mL
per lung
8
Pleural Physiology
  • The area between the pleura is called the pleural
    space (sometimes referred to as potential
    space)
  • Normally, vacuum (negative pressure) in the
    pleural space keeps the two pleura together and
    allows the lung to expand and contract
  • It is also what holds the 2 pleuras together.

9
Review Questions
  • AP of chest (You tube http//www.youtube.com/watc
    h?vwKhldyCC6wg)

10
What happened?
11
What is this?
12
What is this?
archive.student.bmj.com/.../02/education/52.php
13
What is this?What is this movement called?
14
Flail Chest
15
What do you do when a Pleural Injuryoccurs?

16
Pleural Injury Therapeutic Interventions
  • Diagnostic tests
  • Client position
  • Treatment depends on severity
  • Chest tube
  • Heimlich valve on chest tube

17
Chest Tubes
  • Also called thoracic catheters
  • Different sizes
  • From infants to adults
  • Small for air, larger for fluid
  • Different configurations
  • Curved or straight
  • Types of plastic
  • PVC
  • Silicone
  • Coated/Non-Coated
  • Heparin
  • Decrease friction

18
Chest Tube Placement
  • In what setting/environment is a chest tube
    placed?
  • A. Operating Room
  • B. Bedside
  • C. Emergency Room
  • D. All of the above
  • E. None of the above

19
Chest Tube Placement
20
Chest Tube Placement
21
Chest Tube Placement Procedure
  • Sterile technique
  • Small incision
  • Tube is sutured
  • Dressing applied
  • What type?
  • Can the client have 2 chest tubes?
  • When the tube is placed, is it clamped or
    unclamped?
  • why or why not?

22
Chest tube insertion
Choose site
Suture tube to chest
Explore with finger
Place tube with clamp
Photos courtesy trauma.org\
23
Chest tubes in place
24
Heimlich Valve
25
Heimlich ValveWhat are some problems with this
valve?
http//www.scielo.br/img/revistas/jbpneu/v34n8/en_
a04fig01.gif
26
Prevent air fluid from returning to the pleural
space
  • Chest tube is attached to a drainage device
  • Allows air and fluid to leave the chest
  • Contains a one-way valve to prevent air fluid
    returning to the chest
  • Designed so that the device is below the level of
    the chest tube for gravity drainage

27
Treatment goal for pleural injuries
  • 1. Remove fluid air as promptly as possible
  • 2. Prevent drained air fluid from returning to
    the pleural space
  • 3. Restore negative pressure in the pleural space
    to re-expand the lung

28
Interventions
  • Dressing changes
  • When?
  • No dependent loops
  • What is this?
  • Why?
  • Oxygen therapy
  • Record output
  • How often?
  • Analgesics
  • IS and turn, cough, deep breathe

29
What about dependent loops?
30
Nursing assessment and pertinent nursing
problems/interventions
  • Health history-respiratory disease, injury,
    smoking, progression of symptoms
  • Physical exam- degree of apparent resp distress,
    lung sounds, O2 sat, VS, LOC, neck vein
    distention, position of trachea
  • All require observation for respiratory symptoms
  • Pertinent nursing problems
  • Acute pain
  • Ineffective airway clearance
  • Impaired gas exchange
  • Home care

31
  • How a
  • chest drainage system
  • works

32
  • Purpose of Chamber One
  • Correct any fluid comingback from the patient.
  • Purpose of Chamber Two
  • Water seal, one-way valveallows air out of the
    patientbut not back into the patient.
  • Purpose of Chamber Three
  • Suction control. Manual or Fluid filled (most
    hospital systems)

33
Prevent Air and Fluid Backflow
Tube open to atmosphere vents air
Tube from patient
34
Restore negative pressure in the pleural space
  • The depth of the water in the suction bottle
    determines the amount of negative pressure that
    can be transmitted to the chest, NOT the reading
    on the vacuum regulator

35
How a chest drainage system works
  • Expiratory positive pressure
  • Gravity
  • Suction

36
How a chest drainage system works
  • Expiratory positive pressure from the patient
    helps push air and fluid out of the chest (cough,
    Valsalva)
  • Gravity helps fluid drainage as long as the chest
    drainage system is below the level of the chest
  • Suction can improve the speed at which air and
    fluid are pulled from the chest

37
From bottles to a box
From patient
To suction
from patient
Suction control bottle
Water seal bottle
Collection bottle
Suction control chamber
Collection chamber
Water seal chamber
38
From box to bedside
39
Water suction on left Dry suction on
rightLewis p. 589 Fig 28-8
40
(No Transcript)
41
Atrium Chest Tube System
  • Chamber A
  • Suction control chamber
  • How do you know what level the water should be
    at?
  • Chamber B
  • Water seal chamber
  • How do you know what level the water should be
    at?
  • Should the ball be fluctuating in this chamber?
  • What if it isnt?
  • Chamber C
  • Air leak monitor
  • What does bubbling mean?
  • Chamber D
  • Collection chamber
  • When do you record output?

Be sure you under stand how to set up the system,
the function of each chamber and how to
troubleshoot issues with each chamber.
42
(No Transcript)
43
(No Transcript)
44
Monitoring
  • Water seal is a window into the pleural space
  • Not only for pressure
  • If air is leaving the chest through an air leak,
    bubbling will be seen here
  • Air meter (1-5) provides a way to measure the
    air leaving and monitor over time getting
    better or worse?

45
Assessment
  • Focused respiratory assessment
  • Breath sounds
  • Respiratory rate
  • Respiratory depth
  • SpO2
  • ABG
  • CXR

46
Assessment
  • Cardiovascular assessment
  • Level of consciousness
  • Pain
  • Chest tube
  • Amount of drainage
  • Insertion site dressing

47
Interventions r/t chest tubes
  • System position
  • Tubing position
  • What happens when the patient lays on it?
  • Connections to patient and system
  • Assessing the system
  • Monitoring output

48
Complications
  • What are some common complications?

49
Complications Troubleshooting
  • Chest tube malposition (most common)
  • Subcutaneous emphysema
  • What is this?
  • What are some nursing interventions related to
    this complication?
  • High Fluid in Water Seal Chamber
  • Chest system may need to be vented
  • Air leak
  • How do you know?
  • What do you do?
  • Others
  • pleural effusion, inc. pneumo
  • mediastinal shift
  • Do chest tubes get clotted off?
  • What can happen when fluid is removed too fast?

50
If chest tube comes out?
51
Review
  • Check fluid level in suction chamber
  • Observe water seal chamber fluid level
  • Assess for tidaling in water seal chamber
  • Assess for tubing non dependent
  • Determine if the unit has been knocked over
  • Note the amount, color and consistency of
    drainage

52
Review
  • http//www.youtube.com/watch?vw65OgC3mVBk
    (Atriums Set Up part 2, 247)
  • http//www.youtube.com/watch?vWVHelcIIee8 (set
    up part 3 to 5 mins)
  • http//www.youtube.com/watch?v74H6N-Qxm34playnex
    t1listPLFCFEACCE12F1D1E0index26 (dry
    suction start at 510)

53
What is most important?
  • Monitor your client
  • Notify MD STAT if
  • Significant drainage
  • Increasing shortness of breath
  • Pain
  • Absence of breath sounds

54
Management
  • Do not remove suction without an order
  • Manage pain
  • When full - place in biohazard container
  • Do not change collection device on client with an
    air leak without an order
  • When suction discontinued, must disconnect from
    suction, not just turn off

55
Questions
  • What is the progression of events for
    discontinuing a chest tube?
  • Can a patient ambulate with a chest tube?

56
Portable chest drainage system
57
PleurX Catheter
58
Removing the Chest Tube
  • http//www.medicalive.net/186_chest_tube_insertion
  • If time permits
  • http//www.atriummed.com/Products/Chest_Drains/
    edu-ocean.asp
  • Oasis dry suction set up
  • http//www.google.com/imgres?imgurlhttp//www.at
    riummed.com/Common/Images/help-oasis.jpgimgrefurl
    http//www.atriummed.com/products/chest_drains/ed
    ucation.aspusg__iFwkxjbty1SgU2UOxzHu7gyeorMh1
    00w100sz6hlenstart2zoom1um1itbs1tbn
    idbjQxSvGWg2AsiMtbnh82tbnw82prev/images3F
    q3Doasis2Bdry2Bsuction2Bchest2Btube2Bsystem
    26um3D126hl3Den26tbs3Disch1

59
The END
  • Thank you, Thank you, Thank you, Thank you, etc.
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