TEST 3 - Chest Tubes and Ostomy Flashcards
Chest Tube
What is it?
A catheter inserted through the thorax into the pleural space for:
Removing fluid and/or air
Preventing air or fluid from reentering the pleural space
To reestablish normal intrapleural and intrapulmonic pressures
Lung _______________occurs as the fluid or air is removed from the ____________ space.
reexpansion, intrapleural
What are five conditions that require a chest drain insertion
Pneumothorax Haemothorax Pleural effusion Empyema After cardiothoracic surgery
Conditions Requiring Chest Drain Insertion
Pneumothorax
Presence of air in the pleural space. Air can come from the lung, trachea or oesophagus or it can be caused by chest trauma.
Pain (sharp and pleuritic) r/t to atmospheric air irritating the parietal pleural
Dyspnea
Conditions Requiring Chest Drain Insertion
Hemothorax
Collapse of the lung caused by an accumulation of blood and fluid in the pleural cavity
Pain
Dyspnea
Shock if severe blood loss
Conditions Requiring Chest Drain Insertion
Pleural effusion
Accumulation of fluid in the intrapleural spaces Pain Dyspnea Adventitious lung sounds Nonproductive cough Causes: Tumor Infection (Tb) Pulmonary infarction Trauma
Conditions Requiring Chest Drain Insertion
Empyema
Accumulation of pus in the pleural space Cause Bacterial infection (pleurisy, Tb) Pain Dyspnea Fever
Conditions Requiring Chest Drain Insertion
Tension pneumothorax/hemothorax
Air/fluid in the pleural space that does not escape Continued increase in amount of air shifts intrathoracic organs and increases intrathoracic pressure S & S Cyanosis, ↓ O2sat, ↓ BP, ↑ HR Air hunger Violent agitation Tracheal deviation Subcutaneous emphysema Neck vein distention Hyperresonance to percussion ** Medical emergency **
Location of Chest Tubes
For air
Placed high b/c air rises Apical 2nd or 3rd intercostal space Anterior Allows evacuation of air into atmosphere Little or no drainage present in collection chamber Semi-Fowler’s
Location of Chest Tubes
For fluid
Placed low b/c of gravity will localize in the lower portion of the lung cavity when client is sitting upright Usually 5th or 6th intercostal space Posterior or lateral to drain fluid Applying suction assists this drainage High Fowler’s
Location of Chest Tubes
Mediastinal
Placed in the mediastinum just below the sternum
Drains blood and fluid
Attached to drainage system
There will be no tidling (fluctuations) since tube is not placed in lung cavity
Common with open heart surgery
Chest Drainage System
1st compartment
Receives fluid and air from the chest cavity
Fluid stays in chamber while the air vents to 2nd compartment
Chest Drainage System
2nd compartment (water–seal chamber)
compartment (water–seal chamber)
Contains 2 cm of water (acts as one way valve)
Chest Drainage System
3rd compartment (suction control chamber)
Applies controlled suction to the chest drainage system
Suction pressure ordered usually
Rubber flutter one-way valve attached to the catheter
Valve opens whenever the pressure is greater than atmospheric pressure
Closes when the reverse occurs
No drainage chamber is used with this device
Used in emergencies and for some transfers
Hemlick valve
Water-Seal System
Collects air or fluid
As it enters the drainage collection chamber, this air/fluid pushes the air present in the chamber through the water seal and into the atmosphere
Chest tube system must remain upright
If tubing clamped, mechanism won’t work
Two-chamber water-seal system
Water-Seal System
Used when suction required
Chamber is filled to the set volume for the prescribed amount of suction i.e. 20 cm of H20 for a suction of – 20 cm of H20 pressure
Sterile water may need to be added (evaporation)
The wall or portable suction device is turned up until the water in the suction control bottle exhibits a continuous, gentle bubbling
Three-chamber water-seal system
Water-Seal System
Fluid is not required for setup
If system tips, does not disrupt
Water seal replaced with a one-way valve
Suction chamber does not depend on water
Contains a float ball which is set by a suction control dial once suction turned on
15 ml of fluid required for the diagnostic air-leak indicator
Gentle tidaling = normal reexpansion of lung
No tidaling x 2-3 days = fully reexpanded
Fluid bubbling left to right = air leak → must locate leak
Two-chamber waterless system
Expected Drainage
Post-op mediastinal chest tube
< 50 – 200 ml/hr or ~ 500 ml/24 hrs
Sanguinous initially, then serous over time
Expected Drainage
Pleural tube
Btw 100-300 ml in first 3 hours
500-1000 ml/24 hours
Grossly sanguinous in first several hours post-op to serous
Expected Drainage
If sudden gush of dark blood =
client position change
◦dark it’s ok
If _____ _____ or > ____ ml/hr = √ client and notify physician
bright red or > 100 ml/hr
◦fresh blood is emergent and may require further surgery
Milking or stripping creates excessive _______ ________ _________
negative intrapleural pressure
Apprehension
Respiratory distress
Subcutaneous emphysema
Early Signs of Complications
What if:
Air leak unrelated to client’s respirations occurs
Locate source using shodded hemostats
Notify physician
What if:
No drainage
√ for kink
√ for possible clot in chest drainage system
√ mediastinal shift or resp. distress
Notify physician
What if:
Chest tube is dislodged
Immediately apply pressure over chest tube insertion site
Apply an occlusive gauze dressing and tape three sides
Notify physician STAT
Prepare for replacement of the tube
What if:
Substantial ↑ in bright red drainage
√ VS √ drainage √client’s cardiopulmonary status Notify physician Prepare for the OR
