Chest tubes Flashcards
what interrupts the negative pressure system of the lungs?
Trauma, disease, surgery
pneumothorax- air
hemothorax- blood
may leak into the pleural cavity
a closed drainage system and chest tube inserted to promote drainage so lung can reexpand.
thoracostomy tube/thoracic catheter
placement
higher for air and lower for blood/fluid
mediastinal to drain around heart
what is used?
water seal chambers
> fluid drains into the 1st chamber, 2nd chamber contains the water seal which allows air to escape bc of force of expiration but not reenter.
> waterless ones have one-way valves at top of system
> the suction control chamber contains suction controlled float ball that is set by a suction control dial after the suction is connected and turned on.
Assess:
vitals, breathing, Hgb/Hct, resps =, pain
set up water seal
- IDy pt two identifiers
- remain sterile of drain tubingm put sterile water in water seal chamber.
- if it is the suction system. turn onto the prescribed suction. Suction control vent must NOT be occluded!!!**
- tape all tubing connections in double spiral
> clamp drainage tubing until ready to turn on. - unclamp tube and turn on suction.
- assess vitals q 15 min for first 2 hrs, if directly after insertion. and monitor drainage too.
> mediastinal tube- no more than 500mls in 24 hrs
> posterior tube- 500-1000 in 24 hrs
>anterior chest tube (pneumothorax)- little to no output - observe dressing
- palp for SC emphysema (crackling)
- check for leaks
chylothorax
pus pneumonia
pleurodesis
or recurrent malignant effusions
tension pneumothorax
causes mediastinal shifts pushing the heart, great vessels and lungs
S&S: severe resp distress, low O2 sat, chest pain, absence breath sounds, tracheal shift, hypotension and sign of shock, tachycardia
treatment for pleural conditions
- remove fluid and air asap
- prevent drained air and fluid from returning to the pleural space to re-expand the lung
- restore - pressure in pleural space to reexpand lung.
how does it work?
expiratory + pressure from the PT helps push air and fluid out of the chest (cough)
> gravity helps
> suction can help
Pleur-evac
- disposable
- needless
- can be connected to suction or left open to gravity
Consists of:
- collection chamber
- water seal chamber
- suction control chamber
suction control chamber
- upper left side
> -10, -15, -20, -30, -40 cm of h2o
> when attached to suction, increase the amount of wall suction in the window (usually about 80-100)
**note the setting on the unit actually determines the approp amout of suction.
water seal chamber
purpose
prep
Purp- to allow air to exit from pleural space on exhale
prep- pore water in up to 2cm water level
STERILE WATER***
bubble will intermit if cough or a little on exhale if pneumo.
> the air leak meter- indicates degree of leak
shows bubbles in columns
low1 to high 7
+ pressure valve
opens with increase + pressure, preventing pressure accumulation
high - float pressure
preserves water seal in the presence of high negativity. used to reduce -
> water floats the valve up into the closed position when excessive - occurs
Caution!! if suction is not operative while depressing this valve, - pressure may be reduced to zero (atmosphere) and could result in pneumothorax
collection chamber
to collect drainage up to 2500cc
clamp or not?
VERY BIG DEAL only if: > changing vac > assessing the system for leak > after pleurodesis for malignant effusions/sclerosis > prior to the removal of the tube
N, prior to insertion
> informed consent > complete baseline VS >complete rest assess > gather equip >>thoracotomy tray >> chest tube >>dressing material (mepore, drain sponge) >> Pleur-evac
tube size 16-24 fr
N, post insertion
> prep for x-ray > VS > resp asses > palp around site SC emphasema > note drainage > bubbles? > have two clamps near by > 250-500ml bottle of sterile water and 2 alcohol swabs at bedside incase tube disconnects
ongoing PT assess
at start or shift and q 4 hr
> resp > VS > pain > treacha position > dressing D&I > SC emph >system kinks, float
trouble shoot
air leak present- cover with gauze and tape on 3 sides
> occasionally on exhale, gently lift open side to allow air to exit intra-pleural space
no air leak- cover site with occlusive dressing and secure
if tube comes out! put end in bottle of sterile water and call doc
if system tips over, integrity is compromised = replace unit
document
when is it time to come out?
> no air leaks evident the day bfr considering removal
drain less than 50cc/8hr or 100cc/day
pt able to tolerate chest tube drainage system being brought to water seal from suction
chest x-ray shows complete re-expansion of the lung
