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Chest tubes
 

Chest tubes

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    Chest tubes Chest tubes Presentation Transcript

    • 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
    • The pleural space
      • Lies between the parietal pleura (membrane lining the chest cavity) and the visceral pleura (surrounds the lungs)
      • Holds about 50 ml of lubricating fluid
      • Creates a negative pressure that keeps the lungs expanded
      • Excess fluid or air accumulation in the pleural space limits lung expansion and leads to respiratory distress
    • Chest tube indications
      • Pneumothorax: Air in the pleural space caused by trauma, lung disease, invasive pulmonary procedure, forceful coughing, surgical complication, or may occur spontaneously
        • To drain air, the chest tube is placed in anterior chest at the second or third intercostal space
      • Hemothorax: Blood in the pleural space caused by blunt/penetrating trauma or a complication of chest surgery
        • To drain fluid, the chest tube is placed at lung base
      • Pleural effusion: Excessive fluid in the pleural space caused by pneumonia, left ventricular heart failure, pulmonary embolism, cancer, or complication of surgery
    • Chest tube indications
      • Chylothorax: Accumulation of lymphatic fluid in the pleural space caused by chest trauma, tumor, surgery
      • Empyema: Pus from an infection, such as pneumonia; must always be drained no matter how small amount
      • Other considerations: Preventively after cardiac/pulmonary surgery to drain blood postoperatively and prevent cardiac tamponade; also used to instill fluids (chemotherapy, sclerosing agent)
    • Types of CDUs
      • 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
      • 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
    • Types of CDUs
      • Heimlich valve: Contains a one-way flutter valve; air drains out when patient exhales; keep collection device upright and vented to prevent air buildup
      • 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
    • Chest tube insertion
      • Done in patient’s room, interventional radiology, or the operating room
      • Local anesthetic; patient may feel pressure as tube is inserted
      • Aseptic (sterile) procedure
      • Patient’s breathing will be easier once lung is re-expanded
    • Chest tube insertion
      • Position patient for comfort depending on site to be inserted
      • Tube will be anchored with a suture
      • Insertion site will have an occlusive dressing applied
      • Connections securely taped
      • Chest X-ray to confirm position and lung re-expansion
    • Risks and complications
      • Bleeding: Usually minor, but may require surgery if extensive
      • Infection: Likelihood increases the longer the chest tube is in place
      • Subcutaneous emphysema: Characterized by swelling in face, neck, and chest; crackles on palpation
      • 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
    • Nursing considerations
      • Monitor vital signs
      • Assess breath sounds bilaterally
      • Assess the insertion site
      • Encourage the patient to cough
      • Make sure connections are taped securely
      • Keep collection apparatus below the level of the patient’s chest
      • Check water seal and suction control chambers frequently
      • Assess drainage for color
      • Measure drainage every 8 hours or more often depending on patient’s condition
      • Document assessment
      • Report immediately bright red blood or red free-flowing drainage >70ml/hour
      • Reposition patient frequently
    • Care of chest tube and drainage unit
      • Tubing: Avoid loops, aggressive manipulation such as “stripping” or “milking”
      • Patency: To maintain patency, try “gentle” hand-over-hand squeezing of tubing and release
      • Clamping: Avoid except when replacing CDU, locating air leak, or assessing when tube will be removed
    • Removing the chest tube
      • Can remove chest tube when:
      • -- There’s little to no drainage
      • -- Air leak is gone
      • -- Patient is breathing normally without respiratory distress
      • -- Fluctuations in water seal chamber stopped
      • -- Chest X-ray shows lung reexpansion with no
      • residual air or fluid
    • Procedure for chest tube removal
      • Gather supplies and explain procedure to patient
      • The clinician will remove the dressing and sutures
      • During peak exhalation, the clinician will remove the chest tube in one quick movement
      • Immediately apply a sterile gauze dressing containing petroleum to prevent air from entering pleural space
      • Monitor patient’s respiratory status
      • Arrange for chest X-ray to confirm lung reexpansion
      • Monitor patient’s respiratory status and Sp O 2 for 1-2 hours after removal
    • Selected Web sites
      • MedlinePlus Chest tube insertion
      • http://www.nlm.nih.gov/medlineplus/ency/article/002947.htm
      • http://www.nlm.nih.gov/medlineplus/ency/imagepages/9968.htm
      • Nursewise.com: Chest tubes and drainage systems
      • http://www.nursewise.com/courses/chestubes_hour.htm
      • Pneumothorax.org: Is a pneumothorax affecting you?
      • http://www.pneumothorax.org/pneumo.nsf