chest tubes Flashcards
where does the pleural space lie?
between parietal pleura and the visceral pleura
how much fluid can there be in the pleural space?
50ml
What is the purpose of the pleural space?
creat negative pressure that keeps the lungs expanded.
what would happen if there is excess fluid or air accumulation in the pleural space?
limits lung expansion, leads to respiratory distress.
Indications for putting in a chest tube?
ptx htx pleural effusion chtx empyema post-op
what are the two ways of inserting a chest tube?
open –> incisional (preferred, less risk in term of internal organ penetration)
closed –> trocar
where is a chest tube placed?
pleural space: mid axillary or ant axillary (4th ICS) above the upper border of the rib below
what are the risks of chest tube insertion?
- bleeding -injured intercostal a.
- accidental trauma
- infection
- air leak (in tubing)
- improper location/placement
- tension ptx
how should a pt be positioned when inserting a chest tube?
supine or at 45 angle.
decr risk of diaphgram elevation & consequent misplacment of ct into abd space
what is the range of chest tubes that are available?
available in a range of French sizes from 14-40 Fr.
how much does a 28Fr tube drain?
15L/min for AIR, 30x LEss for fluids
what kind of fluid requires a larger bore chest tube?
viscous fluids (pus or blood)
adult or teen male chest tube
28-32 Fr
adult or teen female
28 Fr
child CT size
18Fr
Newborn CT size
12-14 Fr
fluid collects in the _________ portion of the chest cavity
dependent
air collects ni the _________ portion of the chest cavity
non-dependent
insertion site for a ptx
incision @ 4th or 5th intercostal space in the anterior axillary or midaxillary line.
alternative: 2nd ICS in midclavicular line.
safe triangle borders
anterior border of lat dorsi
lateral border of pec major
horizontal level of the nipple, apex below the axilla
