Closed-tube thoracostomy (CTT) involves inserting a chest tube to drain fluid or air from the pleural space and allow the lung to re-expand. CTT is used to treat conditions causing lung collapse like pneumothorax, hemothorax, or empyema. The tube is inserted between the ribs and connected to a drainage system. Nursing care involves ensuring proper drainage and preventing complications like infection. The tube is removed once imaging shows full lung re-expansion.

1. Closed-Tube Thoracostomy
Nelia B. Perez RN MSN

2. Indications for CTT
• If fluid, such as blood, or air, gets into
the pleural space, the lung can collapse,
preventing adequate air exchange.
Chest tubes are used to treat conditions
that can cause the lung to collapse,
such as:
• air leaks from the lung into the chest
(pneumothorax)
• bleeding into the chest (hemothorax)
• after surgery or trauma in the chest
(pneumothorax or hemothorax)
• lung abscesses or pus in the chest
(empyema).

7. PREPARATION
•CXR
•UTZ
•CT SCAN

8. Types of Chest Tube Drainage
1. Three-chamber system: includes one chamber
that serves to collect drainage, one that acts as
water-seal, and one that has levels of water to
control the amount of suction regardless of the
amount of negative pressure applied.
2. Commercially prepared plastic unit designed
for closed chest suction: combines the features
of the other systems and may or may not be
attached to suction (e.g., PleurEvac)

9. Chest Tube Insertion
• Chest tubes are inserted to drain blood, fluid, or air and
allow full expansion of the lungs. The tube is placed in the
pleural space.
• The area where the tube will be inserted is numbed (local
anesthesia). The patient may also be sedated.
• The chest tube is inserted between the ribs into the chest
and is connected to a bottle or canister that contains sterile
water. Suction is attached to the system to encourage
drainage. A stitch (suture) and adhesive tape is used to keep
the tube in place.
• The chest tube usually remains in place until the X-rays
show that all the blood, fluid, or air has drained from the
chest and the lung has fully re-expanded. When the chest
tube is no longer needed, it can be easily removed, usually
without the need for medications to sedate or numb the
patient. Medications may be used to prevent or treat
infection (antibiotics).

10. PROCEDURAL OVERVIEW (537)
• The chest wall is incised.
• A long pean ( or any tube-pulling clamp)is
inserted into the intercostal space. The
tapered end of the tube is placed into the
jaws of the clamp, and the tube is pulled
through the tissue layer.
• The tube is positioned, X-rays are taken are
taken to confirm proper positioning and the
tube is sutured to the skin; the incision is
closed.
• The tube is connected to a sealed drainage
unit.

11. NORMAL RESULTS
• Drainage of pus, blood or gas.
• Lungs reinflate
• Lungs begin to function more
efficiently.
• Site at which the tube was inserted
heals normally.

12. Nursing Care for pt with CTT:
• Ensure that the tubing is not kinked; tape
all connections to prevent separation
• Do not milk the tube
• Maintain the drainage system below the
level of the chest; mark and monitor
drainage
• Turn the client frequently, making sure the
chest tubes are not compressed.
• Observe for fluctuation of fluid in tube; the
level will rise on inhalation and fall on
exhalation; if there are no fluctuations,
either the lung has expanded fully or the
chest tube is clogged

13. Nursing Care for pt with CTT:
• Place two clamps at your bedside for use if the
underwater-seal bottle is broken; clamps are used
judiciously and only in emergency situations
• Encourage coughing and deep breathing every 2
hours, splinting the area as needed
• After lung re-expansion is verified by chest x-ray,
instruct the client to exhale or strain (Valsalva’s
Maneuver) as the tube is withdrawn by the
physician; apply a gauze dressing immediately
and firmly secure the tape to make an airtight
dressing

14. CHANGING CTT BOTTLES
• Identify the patient.
• Prepare all materials needed on
patient’s bedside.
• Wash hands and put on gloves
• Provide privacy.
• Explain to the patient the
procedures.
• Instruct the patient to perform
controlled breathing.

15. • Secure two clamps on rubber tubing.
• Change the CTT drain bottle. NSS
level should be 200 – 300 mL.
• Secure the cover by using plaster.
Make sure that air is unable to
penetrate the closed-system drain.
• Remove the clamps.
• Instruct the patient to perform deep
breathing exercises.
• Observe fluctuation of the NSS inside
the drain bottle.
• Remove gloves.
• Perform Handwashing.

16. Complications of CTT
• Complications of tube
thoracostomy include death,
injury to lung or mediastinum,
hemorrhage (usually from
intercostal artery injury),
neurovascular bundle injury,
infection, bronchopleural fistula,
and subcutaneous or
intraperitoneal tube placement

17. PROVIDING WOUND CARE
Nelia B. Perez
Northeastern College
Santiago City, Philippines

18. WOUND
• The skin is the body’s largest
organ and is the primary defense
of the body.
• A disruption in the integrity of the
body tissue is a wound
• A wound occurs if the integrity of
any tissue is compromised.

20. Types of Wound healing
• Tissue may heal through one or
two methods which are
characterized by degree of tissue
loss.
1. Primary Intention Healing
2. Secondary Intention Healing

21. Primary Intention
• Primary intention healing occurs in
wounds that have minimal tissue
loss and edges that are well
approximated (closed).
• If there are no complications, such
as infection, necrosis, or abnormal
scar formation, wound healing
occurs with minimal granulation
tissue and scarring.

22. Secondary Intention
• Secondary Intention Healing is seen on
wounds with extensive tissue loss and
wounds to which edges can not be
approximated.
• The wound is left open and granulation
tissue gradually fills in the deficit.
• Repair time is longer, tissue
replacement and scarring are greater,
and the susceptibility to infection is
increased because of the lack of an
epidermal barrier to microorganisms.

23. Factors that Affect Wound
Healing
• Age
• Nutrition
• Oxygenation
• Smoking
• Drug therapy
• Diabetes Mellitus

24. Closed Dressings
• Dressings that closed over the
wound.

25. Open dressings
• No dressings that cover the wound

26. Three Layers of Dressings
• First Layer – covers the wound and
collects blood, fibrin and debris.
• Second Layer – collects excess
drainage.
• Third Layer – protects the wound
from external contamination.

27. Purposes of Wound
Dressings
• To promote wound healing.
• To absorb blood and drainage from
the wound.
• To prevent pathogens from
entering the wound.
• To remove drainage, blood, debris
and harmful microorganisms from
the wound.

28. How to perform Wound
dressing
• Identify the patient and explain the
procedure before beginning.
Gather the supplies.
• Provide privacy
• Cleanse hands
• Apply clean gloves
• Remove dressing and place in
appropriate receptacles.

29. • Assess the undressed wound.
• Cleanse the suture line with prescribed
solution.
• Used Applicators should not be
reintroduced into the solution.
• Remove gloves and cleanse hands.
• Apply clean gloves
• Grasping just the edges, apply a new
gauze dressing. Tape lightly.
• Remove gloves and cleanse hands.

30. ANY
QUESTIONS???