3. Diaphragm contracts
Moves down
Increasing the volume of the
thoracic cavity
When the volume increases,
the pressure inside ________.
◦ aka?
Pressure within the lungs is
called intrapulmonary
pressure
4. Phrenic nerve stimulus stops
Diaphragm relaxes
This ______ the volume of
the thoracic cavity
Lung volume decreases,
intrapulmonary pressure
_____.
5. If two areas of different pressure communicate,
gas will move from the area of higher
pressure to the area of lower pressure
6. ◦ Parietal pleura
◦ lines the chest wall
◦ Visceral pleura (pulmonary)
◦ covers the lung
8. • The area between the pleura is called the pleural space
(sometimes referred to as “potential space”)
• Normally, vacuum (negative pressure) in the pleural space
keeps the two pleura together and allows the lung to expand
and contract
• If air or fluid enters this space, there is a potential for
impaired breathing.
15. Diagnostic tests
Client position
Treatment depends on severity
◦ Chest tube
◦ Heimlich valve on chest tube
16. Also called “thoracic catheters”
Different sizes
From infants to adults
Small for air, larger for fluid
Different configurations
Curved or straight
Types of plastic
PVC
Silicone
Coated/Non-Coated
Heparin
Decrease friction
17. In what setting/environment is a chest tube
placed?
◦ A. Operating Room
◦ B. Bedside
◦ C. Emergency Room
◦ D. All of the above
◦ E. None of the above
18.
19.
20. Sterile technique
Small incision
Tube is sutured
Dressing applied
◦ What type?
21. Choose site
Explore with finger
Place tube with clamp
Suture tube to chest
Photos courtesy trauma.org
26. Chest tube is attached to a drainage device
◦ Allows air and fluid to leave the chest
◦ Contains a one-way valve to prevent air & fluid
returning to the chest
◦ Designed so that the device is below the level of the
chest tube for gravity drainage.
27. 1. Remove fluid & air as promptly as possible.
2. Prevent drained air & fluid from returning to
the pleural space.
3. Restore negative pressure in the pleural
space to re-expand the lung.
28. Dressing changes
When?
No dependent loops
What is this?
Why?
Oxygen therapy
Record output
How often?
Analgesics
***Incentive Spirometer (IS) and turn, cough,
deep breathe (TCDB)
29.
30. Health history-respiratory disease, injury, smoking,
progression of symptoms
Physical exam- degree of apparent resp distress,
lung sounds, O2 sat, VS, LOC, neck vein distention,
position of trachea
All require observation for respiratory symptoms
Pertinent nursing problems
◦ Acute pain
◦ Ineffective airway clearance
◦ Impaired gas exchange
33. For drainage, a second
bottle was added
The first bottle collects
the drainage
The second bottle is the
water seal
With an extra bottle for
drainage, the water seal
will then remain at 2cm
If suction is needed, a
third bottle is added.
34. The depth of the
water in the suction
bottle determines
the amount of
negative pressure
that can be
transmitted to the
chest, NOT the
reading on the
vacuum regulator
36. Expiratory positive pressure from the patient
helps push air and fluid out of the chest
(cough, Valsalva)
Gravity helps fluid drainage as long as the
chest drainage system is below the level of
the chest
Suction can improve the speed at which air
and fluid are pulled from the chest
41. Chamber A
◦ Suction control chamber
How do you know what level the water should be at?
Chamber B
◦ Water seal chamber
How do you know what level the water should be at?
Should the ball be fluctuating in this chamber?
What if it isn’t?
Chamber C
◦ Air leak monitor
What does bubbling mean?
Chamber D
◦ Collection chamber
When do you record output?
Be sure you under stand how to set up the system, the function of each
chamber and how to troubleshoot issues with each chamber.
42.
43.
44. Water seal is a window into
the pleural space
Not only for pressure
If air is leaving the chest
through an air leak,
bubbling will be seen here
Air meter (1-5) provides a
way to “measure” the air
leaving and monitor over
time – getting better or
worse?
46. Cardiovascular assessment
Level of consciousness
Pain
Chest tube
◦ Amount of drainage
◦ Insertion site & dressing
47. System position
Tubing position
◦ What happens when the patient lays on it?
Connections to patient and system
Assessing the system
Monitoring output
49. Chest tube malposition (most common)
Subcutaneous emphysema
What is this?
What are some nursing interventions related to this complication?
High Fluid in Water Seal Chamber
Chest system may need to be vented
Air leak
How do you know?
What do you do?
Others
pleural effusion, inc. pneumo
mediastinal shift
Do chest tubes get clotted off?
What can happen when fluid is removed too fast?
50.
51. Check fluid level in suction chamber
Observe water seal chamber fluid level
Assess for tidaling in water seal chamber
Assess for tubing – non dependent
Determine if the unit has been knocked
over
Note the amount, color and consistency of
drainage
55. Monitor your client
Notify MD STAT if
◦ Significant drainage
◦ Increasing shortness of breath
◦ Pain
◦ Absence of breath sounds
56. Do not remove suction without an order
Manage pain
When full - place in biohazard container
Do not change collection device on client with
an air leak without an order
When suction discontinued, must disconnect
from suction, not just turn off
57. What is the progression of events for
discontinuing a chest tube?
Can a patient ambulate with a chest tube?
58.
59.
60. http://www.medicalive.net/186_chest_tube_insertion
If time permits
http://www.atriummed.com/Products/Chest_Drains/edu-ocean.asp
Oasis dry suction set up
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n%2Bchest%2Btube%2Bsystem%26um%3D1%26hl%3Den%26tbs%3Disch:1
