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Go with the Flow of  Chest Tube Therapy By Arlene M. Coughlin, RN, MSN,  and Carolyn Parchinsky, RN, MA Nursing2006,  Marc...
The pleural space <ul><li>Lies between the parietal pleura (membrane lining the chest cavity) and the visceral pleura (sur...
Chest tube indications <ul><li>Pneumothorax:   Air in the pleural space caused by trauma, lung disease, invasive pulmonary...
Chest tube indications <ul><li>Chylothorax:  Accumulation of lymphatic fluid in the pleural space caused by chest trauma, ...
Types of CDUs <ul><li>Chest drainage unit (CDU):  Traditional chest drainage unit consists of a collection chamber, water ...
Types of CDUs <ul><li>Heimlich valve:  Contains a one-way flutter valve; air drains out when patient exhales; keep collect...
Chest tube insertion <ul><li>Done in patient’s room, interventional radiology, or the operating room </li></ul><ul><li>Loc...
Chest tube insertion <ul><li>Position patient for comfort depending on site to be inserted </li></ul><ul><li>Tube will be ...
Risks and complications <ul><li>Bleeding:  Usually minor, but may require surgery if extensive </li></ul><ul><li>Infection...
Nursing considerations <ul><li>Monitor vital signs </li></ul><ul><li>Assess breath sounds bilaterally </li></ul><ul><li>As...
Care of chest tube and drainage unit <ul><li>Tubing:  Avoid loops, aggressive manipulation such as “stripping” or “milking...
Removing the chest tube <ul><li>Can remove chest tube when: </li></ul><ul><li>-- There’s little to no drainage </li></ul><...
Procedure for chest tube removal <ul><li>Gather supplies and explain procedure to patient </li></ul><ul><li>The clinician ...
Selected Web sites <ul><li>MedlinePlus Chest tube insertion </li></ul><ul><li>http://www.nlm.nih.gov/medlineplus/ency/arti...
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Chest tubes

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  1. 1. Go with the Flow of Chest Tube Therapy By Arlene M. Coughlin, RN, MSN, and Carolyn Parchinsky, RN, MA Nursing2006, March 2.5 ANCC/AACN contact hours Online: http://www.nursing2006.com © 2006 Lippincott Williams & Wilkins
  2. 2. The pleural space <ul><li>Lies between the parietal pleura (membrane lining the chest cavity) and the visceral pleura (surrounds the lungs) </li></ul><ul><li>Holds about 50 ml of lubricating fluid </li></ul><ul><li>Creates a negative pressure that keeps the lungs expanded </li></ul><ul><li>Excess fluid or air accumulation in the pleural space limits lung expansion and leads to respiratory distress </li></ul>
  3. 3. Chest tube indications <ul><li>Pneumothorax: Air in the pleural space caused by trauma, lung disease, invasive pulmonary procedure, forceful coughing, surgical complication, or may occur spontaneously </li></ul><ul><ul><li>To drain air, the chest tube is placed in anterior chest at the second or third intercostal space </li></ul></ul><ul><li>Hemothorax: Blood in the pleural space caused by blunt/penetrating trauma or a complication of chest surgery </li></ul><ul><ul><li>To drain fluid, the chest tube is placed at lung base </li></ul></ul><ul><li>Pleural effusion: Excessive fluid in the pleural space caused by pneumonia, left ventricular heart failure, pulmonary embolism, cancer, or complication of surgery </li></ul>
  4. 4. Chest tube indications <ul><li>Chylothorax: Accumulation of lymphatic fluid in the pleural space caused by chest trauma, tumor, surgery </li></ul><ul><li>Empyema: Pus from an infection, such as pneumonia; must always be drained no matter how small amount </li></ul><ul><li>Other considerations: Preventively after cardiac/pulmonary surgery to drain blood postoperatively and prevent cardiac tamponade; also used to instill fluids (chemotherapy, sclerosing agent) </li></ul>
  5. 5. Types of CDUs <ul><li>Chest drainage unit (CDU): Traditional chest drainage unit consists of a collection chamber, water seal chamber, suction control chamber; can drain large amounts of fluid or air </li></ul><ul><li>Smaller/lighter portable CDU: Mechanical one-way valve instead of water seal chamber; good for patient who needs drainage only (not suction to reexpand lung), such as noncomplicated pneumothorax </li></ul>
  6. 6. Types of CDUs <ul><li>Heimlich valve: Contains a one-way flutter valve; air drains out when patient exhales; keep collection device upright and vented to prevent air buildup </li></ul><ul><li>Indwelling pleural catheter: Drains chronic pleural effusions; drains fluid only; can be done at home every 1 or 2 days or when short of breath </li></ul>
  7. 7. Chest tube insertion <ul><li>Done in patient’s room, interventional radiology, or the operating room </li></ul><ul><li>Local anesthetic; patient may feel pressure as tube is inserted </li></ul><ul><li>Aseptic (sterile) procedure </li></ul><ul><li>Patient’s breathing will be easier once lung is re-expanded </li></ul>
  8. 8. Chest tube insertion <ul><li>Position patient for comfort depending on site to be inserted </li></ul><ul><li>Tube will be anchored with a suture </li></ul><ul><li>Insertion site will have an occlusive dressing applied </li></ul><ul><li>Connections securely taped </li></ul><ul><li>Chest X-ray to confirm position and lung re-expansion </li></ul>
  9. 9. Risks and complications <ul><li>Bleeding: Usually minor, but may require surgery if extensive </li></ul><ul><li>Infection: Likelihood increases the longer the chest tube is in place </li></ul><ul><li>Subcutaneous emphysema: Characterized by swelling in face, neck, and chest; crackles on palpation </li></ul><ul><li>Lung trauma/bronchopleural fistula: Rare, but patient will have signs and symptoms of respiratory distress, bloody chest tube drainage; tube will be left in place until healed </li></ul>
  10. 10. Nursing considerations <ul><li>Monitor vital signs </li></ul><ul><li>Assess breath sounds bilaterally </li></ul><ul><li>Assess the insertion site </li></ul><ul><li>Encourage the patient to cough </li></ul><ul><li>Make sure connections are taped securely </li></ul><ul><li>Keep collection apparatus below the level of the patient’s chest </li></ul><ul><li>Check water seal and suction control chambers frequently </li></ul><ul><li>Assess drainage for color </li></ul><ul><li>Measure drainage every 8 hours or more often depending on patient’s condition </li></ul><ul><li>Document assessment </li></ul><ul><li>Report immediately bright red blood or red free-flowing drainage >70ml/hour </li></ul><ul><li>Reposition patient frequently </li></ul>
  11. 11. Care of chest tube and drainage unit <ul><li>Tubing: Avoid loops, aggressive manipulation such as “stripping” or “milking” </li></ul><ul><li>Patency: To maintain patency, try “gentle” hand-over-hand squeezing of tubing and release </li></ul><ul><li>Clamping: Avoid except when replacing CDU, locating air leak, or assessing when tube will be removed </li></ul>
  12. 12. Removing the chest tube <ul><li>Can remove chest tube when: </li></ul><ul><li>-- There’s little to no drainage </li></ul><ul><li>-- Air leak is gone </li></ul><ul><li>-- Patient is breathing normally without respiratory distress </li></ul><ul><li>-- Fluctuations in water seal chamber stopped </li></ul><ul><li>-- Chest X-ray shows lung reexpansion with no </li></ul><ul><li>residual air or fluid </li></ul>
  13. 13. Procedure for chest tube removal <ul><li>Gather supplies and explain procedure to patient </li></ul><ul><li>The clinician will remove the dressing and sutures </li></ul><ul><li>During peak exhalation, the clinician will remove the chest tube in one quick movement </li></ul><ul><li>Immediately apply a sterile gauze dressing containing petroleum to prevent air from entering pleural space </li></ul><ul><li>Monitor patient’s respiratory status </li></ul><ul><li>Arrange for chest X-ray to confirm lung reexpansion </li></ul><ul><li>Monitor patient’s respiratory status and Sp O 2 for 1-2 hours after removal </li></ul>
  14. 14. Selected Web sites <ul><li>MedlinePlus Chest tube insertion </li></ul><ul><li>http://www.nlm.nih.gov/medlineplus/ency/article/002947.htm </li></ul><ul><li>http://www.nlm.nih.gov/medlineplus/ency/imagepages/9968.htm </li></ul><ul><li>Nursewise.com: Chest tubes and drainage systems </li></ul><ul><li>http://www.nursewise.com/courses/chestubes_hour.htm </li></ul><ul><li>Pneumothorax.org: Is a pneumothorax affecting you? </li></ul><ul><li>http://www.pneumothorax.org/pneumo.nsf </li></ul>
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