Thoracostomy Flashcards
What is a thoracostomy?
A procedure where a small thin tube (14 gauge cath) is inserted into the pleural space to remove unwanted air
What are the three types of pnuemothorax
-open
-simple
-tension
What are the indications for a thoracostomy
Suspected or confirmed tension pneumothorax with signs of clinical deterioration
What are the contraindications for a thoracostomy
There aren’t any
What is a pneumothorax
-collection of air in the pleural space
—can be simple or develop into a tension
- present in 15-50% of chest trauma
What causes a pneumothorax
central line placement
Chest surgery
Trauma to the chest wall
Traumatic intubation
Mechanical ventilation
What are signs and symptoms of a pneumothorax
-absent breath sounds
-decreased chest wall movement on the effected side
-difficulty breathing
-tachycardia
-anxiety
Restlessness
Decreased SpO2
Increased Peak Airway Pressures
Cyanosis
Complaints of pleuritic-type chest pain
Increased resp rate
Pain worsens when the pt attempts to breathe
Equipment needed for a thoracostomy
-Cleansing agent
14 or 16 gauge needle
10ml syringe
Adhesive bandage
3 way stop cock
Primary Insertion site
Midclavicular, second intercostal space, riding the 3rd rib
Secondary insertion site
Mid axillary 5th intercostal riding the sixth rib
Thoracostomy management
What for dislodgement
Burping the valve or stopcock may be required if SOB returns
Monitor vitals and pt
Chest tube insertion in mandatory after thoracostomy
Complications of a thoracostomy
-failure to decompress
-bleeding
Pneumothorax
Infection
What are the two pleural membranes
-visceral
-parietal
What is a pleural effusion
The accumulation of pathological quantities of fluid in the intrapleural space
What causes a pleural effusion
-liver and kidney failure
-CHF
-Infection
-Malignancy
What is Empyema
Inflammatory fluid and debris within the intrapleural space. Usually results from an untreated bacterial pneumonia
What causes empyema
-thoracic trauma
-rupture of lung abscess into the pleural space
Extension of mediastinal or abdominal infection
Iatrongenic at time of surgery
Signs and symptoms of empyema
Absent b/s
Decreased chest rise and fall
Difficulty breathing
Tachycardia
Anxiety
Restlessness
Decreased SPO2
Pleuritic chest pain
Increased RR
Pain worsens with deep breathing
Equipment needed for a chest tube
Chest tube tray
Tube
Local anesthetic
Betadine
Suturing supplies
Sterile gloves
2 1000cc of sterile water
4x4 suction setup
Chest tube collection system
Vaseline gauze
Silk tape
What does 3 bottles with a chest tube mean
Valve + drainage +pull
-allows air in but not out
-rise and fall of fluid with breathing
-allows for collection
Creates negative pressure
What does one bottle with a chest tube mean
Allows air out but not in
Rise and fall of fluid with breathing
Creates no suction
Not intended for collection
What does the first chamber in the pleurovac unit do
Drainage
What does the second chamber of the pleruovac do?
Water seal / one way valve
What does the third chamber of the pleruovac do?
Suction chamber
What are the two nevers
Never allow tubing to dangle
Ensure the collection unit never goes above chest level
