Adult Health Nursing topic

1. Chest Tubes….Just
Another Drain
By
Anandh Sam Perera
Professor

2. Caring for a Patient with a Chest
Tube
 Let’s review some A & P
 The lungs are wrapped by a double sided
envelope of tissue called the Pleura.
 The inner most layer is called the Visceral
Pleura
 The outer most layer is called the Parietal
pleura

3. How We Breathe….
On inspiration, the lungs move downward.

4. The visceral and parietal pleura are
separated by a thin film of serous fluid
On inspiration, the chest wall expands
and the diaphragm moves down
During inspiration, the pressure within
the thoracic cavity is lower than
atmosp. pressure so air can rush in the
lungs

5.  During expiration, the intrathoracic
pressure is greater - allowing air to exit the
lungs.
 If air or blood is introduced into the pleural
space, the normal pressures are disrupted
and the lung or lungs will collapse.
 To drain this air and/or fluid off the pleural
space, a chest tube is NEEDED.

6. Indications for Chest Tube
Insertion
 Pneumothorax: Presence of air in the
pleural space
 Hemothorax: Presence of blood in the
pleural space
 Hemopneumothorax: Presence of air and
blood in the pleural space

7. Chest Tube Insertion
 Pneumothorax: Chest tube will be placed
at 2nd intercostal space
 Hemothorax: Chest tube will be placed in
the 5th/6th or 8th/9th intercostal space

9. Types of Drainage Systems
Glass Bottle System:
1 bottle
2 bottle
3 bottle
Plastic System:
Thoraseal
Pleuravac

11. Principles of Chest Tube
Functioning
 The idea is to create a one way
mechanism that will let air out of the
pleural space and prevent outside air from
coming in….why would this be a problem?
 This is accomplished by the use of an
underwater seal. The distal end of the
drainage tube is submerged in 2cm of
H2O.

12. Question????
 How would the waterseal help in restoring
negative intrathoracic pressure??

13. To Clamp or Not to Clamp????
 What would happen if the chest
tube exiting the patient’s chest
became kinked or clamped????
 Would it make a difference if it was
a pneumo vs a hemothorax?

15. Tension Pneumothorax…Paging
Dr. Carter
 Trachea is deviated
 Decreased or absent breath sounds on
affected side
 Blood pressure drops
 Tachycardia
 Dyspnea, Hypoxia, Hypoxemia
 Decreased Cardiac Output

16. Care of the Patient with a
Chest Tube

18. Atrium Chest Drainage
System

19. Now Let’s Meet The Patient…..

23. Open Pneumothorax
 Air enters the pleural space
through an actual opening in the
chest wall. Can you name some
examples of how an open pneumo
can occur?

24. Closed Pneumothorax
 Air enters the pleural space
without any external
wound…..originates from within.
Can you name some examples
which would cause a closed
pneumo?

25. Nursing Responsibilities/Care of
Patient with Chest Tube
 Keep drainage system 2-3 feet below
patient’s chest
 Keep tubing patent; make sure no kinks or
clots present
 Observe and record amount of drainage.
>100cc/hr is heavy…notify physician.
 Encourage TCDB, ambulation as ordered.

26. When a patient has a chest tube to
gravity drainage, the nurse should:
 A. Position the patient on his back
 B. Restrict the patient of bedrest
 C. Provide long tubing to reach the
suction source
 D. Keep the drainage chamber below
chest level

27. The nurse knows to clamp the chest
tube if:
 A. The drainage unit is disrupted or
broken.
 B. The patient develops a tension
pneumothorax.
 C. Locating a source of an air leak.
 D. The patient must be transported.

28. Any Questions???

29. The End…….