Title: Chest Tubes
1Chest Tubes
- by Charlotte Cooper RN, MSN, CNS
- modified by Kelle Howard RN, MSN
2Thoracic Cavity
- Lungs
- Mediastinum
- Heart
- Aorta and great vessels
- Esophagus
- Trachea
3Breathing Inspiration
- Diaphragm contracts
- Moves down
- Increasing the volume of the thoracic cavity
- When the volume increases, the pressure inside
________. - Pressure within the lungs is called
intrapulmonary pressure
4Breathing Exhalation
- Phrenic nerve stimulus stops
- Diaphragm relaxes
- This ______ the volume of the thoracic cavity
- Lung volume decreases, intrapulmonary pressure
_____
5Physics of Gases
- If two areas of different pressure communicate,
gas will move from the area of higher pressure to
the area of lower pressure
6Pleural Anatomy
-
- Parietal pleura
- lines the chest wall
- Visceral pleura (pulmonary)
- covers the lung
7Pleural Anatomy
Visceral pleura
Parietal pleura
Lung
Ribs
Intercostal muscles
Normal Pleural Fluid Quantity Approx. 20 -
25mL per lung
8Pleural Physiology
- Area between pleura ----potential space
- Normally, negative pressure between pleura
9What happened?
10What is this?
11What is this?
archive.student.bmj.com/.../02/education/52.php
12What is this?
13Flail Chest
14Pleural InjuryOccurs
15Pleural Injury Therapeutic Interventions
- Diagnostic tests
- Client position
- Treatment depends on severity
- Chest tube
- Heimlich valve on chest tube
16Chest 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
17Chest Tube Placement
- In what setting/environment is a chest tube
placed?
18Chest Tube Placement
19Chest Tube Placement
20Chest Tube Placement Procedure
- Sterile Tech
- Small incision
- Tube is sutured
- Dressing applied
21Chest tubes in place
22Heimlich Valve
23Heimlich Valve
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a04fig01.gif
24Prevent 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
25Treatment 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
26Interventions
- Dressing changes
- No dependent loops
- Oxygen therapy
- Record output
- Analgesics
- IS and turn, cough, deep breathe
27Nursing 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
28- How a
- chest drainage system
- works
29Prevent Air and Fluid Backflow
Tube open to atmosphere vents air
Tube from patient
30Prevent Air and Fluid Backflow
- For drainage, a second bottle was added
- The first bottle collects the drainage
- The second bottle is the water seal
- With an extra bottle for drainage, the water seal
will then remain at 2cm
31Restore 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
32How a chest drainage system works
- Expiratory positive pressure
- Gravity
- Suction
33(No Transcript)
34What is different about this system?
35Atrium Chest Tube System
- Chamber A
- Suction control chamber
- Chamber B
- Water seal chamber
- Chamber C
- Air leak monitor
- Chamber D
- Collection chamber
-
- Be sure you under stand how to set up the system,
the function of each chamber and how to
troubleshoot issues with each chamber.
36Monitoring
- 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?
37Assessment
- Focused respiratory assessment
- Breath sounds
- Respiratory rate
- Respiratory depth
- SpO2
- ABG
- CXR
38Assessment
- Cardiovascular assessment
- Level of consciousness
- Pain
- Chest tube
39Interventions r/t chest tubes
- System position
- Tubing position
- Connections to patient and system
- Assessing the system
- Monitoring output
40Complications
- What are some common complications?
41Complications Troubleshooting
- Chest tube malposition (most common)
- Subcutaneous emphysema
- High Fluid in Water Seal Chamber
- Chest system may need to be vented
- Air leak
- Others
- pleural effusion, inc. pneumo, pulmonary edema
- mediastinal shift
- ?
42If chest tube comes out?
43Review
- 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
44What is most important?
- Monitor your client
- Notify MD STAT if
- Significant drainage
- Increasing shortness of breath
- Pain
- Absence of breath sounds
45Management
- 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
46Questions
- What is the progression of events for
discontinuing a chest tube? - Can a patient ambulate with a chest tube?