• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
2. chest tube drainage
 

2. chest tube drainage

on

  • 4,654 views

pleural effusion

pleural effusion

Statistics

Views

Total Views
4,654
Views on SlideShare
4,654
Embed Views
0

Actions

Likes
6
Downloads
150
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    2. chest tube drainage 2. chest tube drainage Presentation Transcript

    • Chest Tubes
    • The Mechanics of BreathingIn normal situations, the pressurebetween the pleura of the lungs isbelow atmospheric pressure.When air or fluid enters the intrapleuralspace, the pressure is altered, and thiscan cause collapse of a portion of thelung.
    • Even with adequate oxygenation andan open airway, a patient with acollapsed portion of the lung will nothave adequate oxygen - carbon dioxideexchange.The only treatment for this alteredcondition is to restore the negativepressure to the intrapleural space. Thisis accomplished through the use of achest tube.
    • Pneumothorax
    • Indication of Chest IntubationDrain pleural fluid or air promote lung expansion1. Pneumothorax2. Hydrothorax3. Hemothorax4. Chylothorax5. Pyothorax6. Post-thoracotomy etc.
    • Size of Chest TubeAdult or Teen Male 28-32 FrAdult or Teen 28 FrFemaleChild 18 FrNewborn 12-14 Fr
    • Pleural aspiration/drainage:Complications: Pneumothrax, apprehension, increase restlessness, tension pneumothorax, dysponea, chest pain, tachycardia, etc.Position : Pneumothrax = 2nd ICS : Haemo/pyo thorax = 4-6th ICS. 2009 Trauma Guidelines: 5th Intercostal Space, outer side of mid axillaries line.
    • Nursing Assessment FindingsDiminished or absent Decreased oxygenbreath sounds on saturationaffected side. Increased Peak AirwayDecreased chest wall Pressuresmovement on affected Cyanosisside. Complaints of pleuritic-Difficulty breathing. type chest painTachycardia Increased respiratoryAnxiety rateRestlessness Pain may worsen when attempting to breathe deeply
    • Equipment needed for Chest Tube Setup 2- 1000cc bottles Chest tube of sterile water or insertion tray Plastic bag Tube (appropriate 4 x 4’s gauze pad size) Suction setup Local Anesthetic (Xylocaine) Suction tubing Betadine (or other Chest tube antiseptic) collection system Suturing supplies Vaseline Gauze Sterile gloves Tape
    • Surgical Procedure Steps
    • Apparatus of Chest Tube Drainage: (old method)1. Underwater sealed bottle: Separate from atmosphere2. Collecting bottle: Decrease resistance of drainage3. Negative pressure suction: Promote lung expansionRecently we use chest tube with plastic bag
    • InsertionThe patient will need to be positionedaccording to where the chest tube will beplaced.Typically having the patient’s arms overtheir head.Pre-medicate the patient with sedation &pain medicine as per order.
    • Procedure of Chest Intubation1. Local anesthesia, confirm location2. Skin incision at selected area with 11 no blade3. Dissect into pleural cavity thru a subcutaneous tunnel4. Locate pleural cavity5. Insert tube posteriorly and laterally6. Close incision wound, fixed the tube7. Connect tube to underwater sealed bottle (or with negative pressure suction)
    • Attention in Massive Subcutaneous (Mediastinal) Emphysema:1. Keep airway patent (even endotracheal tube)2. CXR3. Insert chest tube in pneumothorax or suspicious side4. Connect tube to negative pressure suction immediately5. Close thoracostomy edge slightly loose6. Insert another tube if no improvement7. Low O2 nasal cannula8. Determine the cause & treat underlying disease9. Remove tube after complete subsidence
    • Post-Insertion DocumentationReason for chest tube Dressing type applied.placement. Connections securelyPatient vital signs. taped.Any medications given. Vital signs during/postLocation & size of chest tube. procedure.Patient’s tolerance of Water level ordered & setprocedure. for suction control chamber.Drainage received (if any):color, characteristics, Post-insertion chest x-rayvolume, etc. taken.
    • Maintenance of Chest TubesCardiovascular assessments must be performedevery 4 hours at least for all patients with chesttubes.Encourage patient to cough & deep breathe.Check insertion site every morning at 0800 andreplace dressing at that time.Assess water levels in drainage unit each shift andcorrect fluid levels if not as ordered.Report to Physician immediately any change orcomplication with the chest tube.
    • Dressing Change
    • Maintenance of Chest TubesCheck all tubing connections and re-tape asneededI & O to be completed (and marked oncollection chamber).Monitor for air leaks, chest x-ray results,oxygen saturations, and peak airwaypressures.Report any alterations immediately.
    • Maintenance of Chest TubesKeep tubing coiled on bed, NEVER allowtubing to dangle.Ensure that bedside collection unitNEVER goes above chest level.
    • Tubing Placement
    • Potential Sources of Air LeaksPoor tubing connections.Tube dislodgement from pleural space.Cracked bedside collection unit.To locate air leak, clamp the tubingmomentarily at various points along tubinglength.
    • Nursing Care: Informed consent signed. Any allergy identified. Sedative given if prescribe. Inform patient about all procedures and needs for better cooperation. Make patient comfortable with adequate support (Bedside, cardiac table, stand chair). Support and re-assure the patient during procedure
    • Nursing Care: After needle with drawn pressure applied at site and small dressing applied. Patient is kept on bed rest. Record: details of fluid and any complains. Evaluate Patients after procedure
    • Chest drainage.Two chest drain may join with YJunction to same drain container. Butpreferably leave separate.
    • Guidelines for the managementof chest drainage: (Plastic bag). Drainage tube should be attached to chest bag and submerged 2.5 cm below water level. Short tube left open to atmosphere. Original fluid level should be marked and daily/hourly recorded. Drainage tube should be fastened to avoid kinking.
    • Encourage Pt. to change position frequently.Give adequate analgesic and encouragephysiotherapy.Ensure fluctuation of fluid level.Stop when: - Lung re-expand.• Tube blocked.• Dependent loop.
    • Watch for air leak-report immediately.(Air bubbling in fluid column).Avoid clamping: may create tension pneumothorax.Observe and report – Rapid shallow breathing.• Cyanosis• pressure in chest.• Subcutaneous emphysema.• Excessive hemorrhage• respiratory status and vitals.
    • Encourage deep breathing and coughing atfrequent interval.Keep drainage bag below chest level.Checking dressing.Sterile gauze and a padded clamp should bekept at the bedside for emergency use if tubeis accidentally dislodged or disconnected.
    • Drainage assessment: every hr till 24 hrs,then 8 hrs subsequently.Physician should notify if drainage exceed100 ml/hr.Assist physician while inserting andremoving tube. (e.g. ask pt. to hold breath)
    • Removal of Chest TubeIndications • No fluctuation in the fluid column of the tube (complete lung reexpansion or tube occlusion) • Daily fluid drainage <100ml in 24 hours (< 50 c.c./day) • Air leakage has stoppedProper timing (controversy) • Spontaneous pneumothorax after thoracostomy – removal tube within 6 hours of reexpansion--25% collapse
    • When to Remove Chest Tube ?Criteria: 1. No air leakage 2. Drained fluid < 50 c.c./day 3. Clear serosanguineous color of fluid 4. Full expansion of lung in CXR Clear sterile fluid remove directly Turbid, infected fluid withdraw progressively
    • 9-S for successful, safe chest tube insertion:1. sedation: Adequate analgesia2. Site: a safe area above the nipple, posterior to the anterior axillarys fold should be chosen. (5th ICS)3. Sensitive: finger dissection will reduce insertion complications.4. Sterility: single dose antibiotic :Prophylaxis5. Suturing: to fix drain with heavy silk
    • 6. suction: applied to drain (=20 cm of water)7. Seal carefully: on removal of tube8. Side effects: RT poor technique9. Sessions: CME/Procedural Exposure.
    • Thank You
    • Extra Slides
    • Components of the Chest Tube Drainage SystemSuction controlchamberWater Seal ChamberCollection chamber
    • Suction Control ChamberThe use of suction helps overcomean air leak by improving the rate of airand fluid flow out of the patient.Lower the water content, lower thesuction. Raise the water level, raisethe amount of suction.
    • Water Seal Chamber The water seal chamber which is connected to the collection chamber, allows air to pass down through a narrow channel and bubble out through the bottom of the water seal. Continuous bubbling confirms a persistent air leak.
    • Collection ChamberFluids draindiirectlyfrom patientinto thecollectionchamber viaa 6’ patienttube.
    • Preparing for InsertionGather supplies.Prepare patient.Open chest drainagesystem.Swing out floor standto stabilize the unit.Close suction controlstopcock.
    • Components of the Chest Tube Drainage SystemSuction controlchamberWater Seal ChamberCollection chamber
    • Suction Control ChamberThe use of suction helps overcomean air leak by improving the rate of airand fluid flow out of the patient.Lower the water content, lower thesuction. Raise the water level, raisethe amount of suction.
    • Water Seal Chamber The water seal chamber which is connected to the collection chamber, allows air to pass down through a narrow channel and bubble out through the bottom of the water seal. Continuous bubbling confirms a persistent air leak.
    • Collection ChamberFluids draindiirectlyfrom patientinto thecollectionchamber viaa 6’ patienttube.