Care of client with chest tube

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chest tube care

chest tube care

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  • 1. Care of Clientwith under waterseal drainage
  • 2. is a flexible plastictube that is insertedthrough the side of thechest into the pleuralspace to reexpandthe lung.
  • 3. Purpose Itis used to remove air , fluid or pus. To establish normal negative pressure in the pleural cavity for lung expansion. To equalize pressure on both sides of the thoracic cavity. To provide continuous suction to prevent tension pneumothorax.
  • 4. Indication Pneumothorax: accumulation of air Pleural effusion: accumulation of fluid Chylothorax: a collection of lymphatic fluid Empyema: a pyogenic infection of the pleural space Hemothorax: accumulation of blood Hydrothorax: accumulation of serous fluid
  • 5. ContraindicationBleeding diathesisCoagulopathy
  • 6. Pre Procedure1. Confirm the procedure2. Inform patient3. Check for the consent4. Prepare the equipments5. X-ray (with the report to determine the affected lung)6. Position patient
  • 7. Observe/monitor patient’s Respiration SaturationReduce patient’s anxietyPrepare the under water sealConnect the closed system fast
  • 8. Post procedure Monitor vital signs  15min x 1 hour  30mins x 1 hour  1 hour x 4 hours and until stable Take note of the respiration  Rate  Pattern  Rhythm Check saturation  Administer oxygen when necessary
  • 9. Post procedure1. Care of patientRespiratory status Auscultates lungs to assess air exchange in the affected lung Place patient in fowler’s position
  • 10.  Change the gauze when necessary Strict aseptic technique when performing dressingCheck skin integrity o Redness o Swelling o Loose suture
  • 11.  Intact and taped Maintain patency  Check for obstruction Teach patient on how to take care of the tubing  Place a pillow between patient and tubing  Coil the tube  Avoid dependent loop  Instruct patient to cough if tube is blocked  Milking and stripping of the tube when blocked
  • 12.  Use rubber tips Clamped at the bedside Clamping  During transfer  Not more than 1 minute  Upon doctor’s order Note: clamping chest tube will accumulate in the pleural cavity since the air has no means of escape. This can rapidly lead to tension pneumothorax.
  • 13. 3 principles of under watersealGravityWater sealSuction
  • 14. Enhances flow from high to low.Place below patient’s chest wall (gravity)Fill with sterile water.Rod must be immersed 2cm in water.Observe for the fluctuation of water level.
  • 15. 5(a) Fluctuation To ensure the patency of the system It will stop when :  lung fully expanded  an obstruction Check for obstruction  Tubing –kinked  Patient’s position  Ask patient to take a deep breath and cough
  • 16. 5(b) Bubbling Intermittentbubbling : normal Continous bubbling : abnormal  Check : Wound Tube Connection If rapid bubbling without air leak : inform doctor immediately
  • 17. 5(c) Drainage output70-100 mls per hour observe for any change in drainage colour Mark the amount Document in I/O chart Change bottle every 24hours or when full
  • 18. 6. Suction apparatus1. Low suction pump  Must be controlled  Suction valve / meter is inserted for wall suction  Check for bubbling  If no bubbling  Clamp chest tube to check for air leaks  Check tubing and connection  Observe patient’s condition while chest tube is clamped.
  • 19. 7. Safety1. Tube  Prevent kinking  Place a pillow as barrier  Never clamp unnecessarily2. Bottle  Must be below chest  Keep bottle in basin  Inform relatives and housekeeping
  • 20. 8. AmbulationEncourage patient to change position to promote drainageNo need to clamp the tubeMaintain chest tube below chest wall
  • 21. 9. ExerciseEncourage deep breathing and arm exercise.On the first post op day.When patient not in severe pain.Assist patient. To enhance the lung expansion Prevent stiffness of the arm
  • 22. 10. ComfortAdminister analgesic in the first 24hours.Allow position that comfortable to the patient .Assist patient in daily living activity Hygiene
  • 23. Removal of chest tubeAssessment X-raydone to check the progress Clamp for 2 hoursChest tube removed
  • 24. Emergency careBleeding Observe wound dressing Observe drainageDislodgement From insertion site : place a gauze immediately From connection : clamp chest tube immediately
  • 25. Emergency care…Bottle breaks Identify either patient having pneumothorax or hemothorax. Observe patient for tension pneumothorax. Place tube in saline immediately. Unclamped immediately. (prevent respiratory distress)Elevation of bottle Immediately inform doctor
  • 26. ComplicationBleedingPulmonary embolusCardiac tamponadeAtelectasis