Chest Tubes Flashcards
Is the pleural space normally positive or negative pressure?
Normally negative pressure
What is pneumothorax?
The parietal or visceral pleura is breached and the pleural space is exposed to positive atmospheric pressure
Air enters the pleural space and the lung collapses
What are 3 types of pneumothorax?
- Simple
- Traumatic
- Tension
What is simple pneumothorax?
Occurs when air enters the pleural space through a breach of either parietal or visceral pleura
T or F:
Simple pneumothorax will NOT occur in an otherwise healthy person
F, it can
What in simple pneumothorax associated with?
- Diffuse interstitial lung disease
- Severe emphysema
Mnfts of simple pneumothorax?
5
- Minimal respiratory distress with slight chest
discomfort and tachypnea - Trachea midline
- Expansion decreased
- Breath sounds diminished
- Percussion reveals normal or hyperresonance
When does traumatic pneumothorax occur?
When air escapes from a laceration in the lung itself or enters through a wound in the chest wall
Traumatic pneumothorax is often accompanied by ___________
Hemothorax
What is open pneumothorax?
Pneumothorax that occurs when a wound in the chest wall is large enough to allow air to pass freely in and out of the thoracic cavity with each attempted respiration
What are “sucking chest wounds”?
During open pneumothorax, the attempted resps make a sucking sound
What is the term used when the lung collapses and the structures of the mediastinum shift toward the uninjured side with each inspiration and in the opposite direction with expiration?
Mediastinal flutter or mediastinal swing
What is tension pneumothorax?
Air enters the pleural space from a lacerated lung or a small hole in the chest wall, the air that enters is trapped and can’t be expelled during expiration.
With each breath tension (positive pressure) increases causing the lung to collapse and the heart, great vessels and trachea to shift toward the unaffected side
How is CO affected by tension pneumothorax? Explain.
Increased pleural pressure decreases venous return to the heart
Mnfts of tension pneumothorax?
know at least 3
- Trachea shifted away from affected side
- Chest expansion decreased of fixed in
hyperexpansion state - Breath sounds diminished or absent
- Percussion to affected side is hyperresonant
- Air hunger, agitation, hypoxemia, central cyanosis,
hypotension, tachycardia, diaphoresis - Chest pain, low oxygen sats
In an emergency situation how can tension pneumothorax be decompressed?
By inserting a large bore (14g) needle at the second intercostal space, midclavicular on the affected side
When would a pt receive a thoracotomy (surgical opening of the chest wall)?
When there is more than 1500mL of blood aspirated initially or when chest tube output continues > 200mL/hr
How much fluid should normally be in the pleural space?
7-20mL of fluid
What conditions can increase pleural fluid entry or decrease fluid exit from the lung?
- Cancer
- Infection
- Pancreatitis
- Connective tissue disease
- Autoimmune diseases
- Asbestos exposure
- Some drugs
- Collagen vascular diseases
What is spontaneous/primary pneumothorax?
D/t rupture of a small bleb (blister) on the surface of the lung or an invasive procedure
What is secondary pneumothorax?
D/t underlying disease such as emphysema
What is hemothorax?
Collapse of the lung caused by accumulation of blood and fluid , usually d/t trauma
Which insertion site for chest tubes promotes air removal?
Apical (2nd or 3rd intercostal space) and anterior chest tubes
Which insertion site for chest tubes drain fluid?
Low (5th or 6th intercostal space) and posterior or lateral chest tubes
Where are mediastinal chest tubes placed? What is their role?
Just below the sternum and drains blood or fluid preventing accumulation around the heart
What is a Heimlich valve? When is it used?
A one way valve used for air to be released but can’t re-enter
What are the systems of choice for draining hemo/pnuemothorax?
Two or three chamber drainage systems drain hemothorax and pneumothorax effectively
What is used to remove secretions when a small chest tube becomes blocked with blood clots?
Large bore catheter (28F)
T or F:
Milking/stripping tubes causes a dec in intrathoracic pressure
F, causes a dangerous increase
2 easy ways to avoid occlusion of chest tube drainage?
- Avoid dependent loops - if they cannot be avoided,
lift and clear every 15-30 minutes - Keep the system below the chest
How do the fluid levels on a chest tube system change during respirations? Is this different for pts on a ventilator?
Fluid levels will rise during inspiration and fall during expiration, but if they are on a ventilator it will do the opposite
What might indicate a leak in the chest tube?
Constant left-to-right bubbling or violent rocking
How often should you monitor chest tubes?
Monitor every hour initially, then every 4 hours
What does frank blood in chest tubes indicate?
Hemothorax
What does pus in chest tubes indicate?
Empyema
What does continuous bubbling in the water-seal chamber with an absence of bubbles in the suction-control chamber indicate?
A leak
What should you do if the chest tube becomes dislodged?
Apply pressure and a petroleum gauze dressing on pt exhale
What is considered excessive chest tube drainage in children?
3mL/lg/hr for more than 3 consecutive hours
