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Chest Tubes

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Chest Tubes Author: Charlotte ... Exhalation Physics of Gases ... Flail Chest Pleural Injury Occurs Pleural Injury: Therapeutic Interventions Chest Tubes Chest ... – 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

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
    ________.
  • 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
Visceral pleura
Parietal pleura
Lung
Ribs
Intercostal muscles
Normal Pleural Fluid Quantity Approx. 20 -
25mL per lung
8
Pleural Physiology
  • Area between pleura ----potential space
  • Normally, negative pressure between pleura

9
What happened?
10
What is this?
11
What is this?
archive.student.bmj.com/.../02/education/52.php
12
What is this?
13
Flail Chest
14
Pleural InjuryOccurs
15
Pleural Injury Therapeutic Interventions
  • Diagnostic tests
  • Client position
  • Treatment depends on severity
  • Chest tube
  • Heimlich valve on chest tube

16
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

17
Chest Tube Placement
  • In what setting/environment is a chest tube
    placed?

18
Chest Tube Placement
19
Chest Tube Placement
20
Chest Tube Placement Procedure
  • Sterile Tech
  • Small incision
  • Tube is sutured
  • Dressing applied

21
Chest tubes in place
22
Heimlich Valve
23
Heimlich Valve
http//www.scielo.br/img/revistas/jbpneu/v34n8/en_
a04fig01.gif
24
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

25
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

26
Interventions
  • Dressing changes
  • No dependent loops
  • Oxygen therapy
  • Record output
  • Analgesics
  • IS and turn, cough, deep breathe

27
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

28
  • How a
  • chest drainage system
  • works

29
Prevent Air and Fluid Backflow
Tube open to atmosphere vents air
Tube from patient
30
Prevent 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

31
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

32
How a chest drainage system works
  • Expiratory positive pressure
  • Gravity
  • Suction

33
(No Transcript)
34
What is different about this system?
35
Atrium 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.

36
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?

37
Assessment
  • Focused respiratory assessment
  • Breath sounds
  • Respiratory rate
  • Respiratory depth
  • SpO2
  • ABG
  • CXR

38
Assessment
  • Cardiovascular assessment
  • Level of consciousness
  • Pain
  • Chest tube

39
Interventions r/t chest tubes
  • System position
  • Tubing position
  • Connections to patient and system
  • Assessing the system
  • Monitoring output

40
Complications
  • What are some common complications?

41
Complications 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
  • ?

42
If chest tube comes out?
43
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

44
What is most important?
  • Monitor your client
  • Notify MD STAT if
  • Significant drainage
  • Increasing shortness of breath
  • Pain
  • Absence of breath sounds

45
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

46
Questions
  • What is the progression of events for
    discontinuing a chest tube?
  • Can a patient ambulate with a chest tube?
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