Thoracostomy

Question 1

What is a thoracostomy?

Answer 1

A procedure where a small thin tube (14 gauge cath) is inserted into the pleural space to remove unwanted air

Question 2

What are the three types of pnuemothorax

Answer 2

-open
-simple
-tension

Question 3

What are the indications for a thoracostomy

Answer 3

Suspected or confirmed tension pneumothorax with signs of clinical deterioration

Question 4

What are the contraindications for a thoracostomy

Answer 4

There aren’t any

Question 5

What is a pneumothorax

Answer 5

-collection of air in the pleural space
—can be simple or develop into a tension
- present in 15-50% of chest trauma

Question 6

What causes a pneumothorax

Answer 6

central line placement
Chest surgery
Trauma to the chest wall
Traumatic intubation
Mechanical ventilation

Question 7

What are signs and symptoms of a pneumothorax

Answer 7

-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

Question 8

Equipment needed for a thoracostomy

Answer 8

-Cleansing agent
14 or 16 gauge needle
10ml syringe
Adhesive bandage
3 way stop cock

Question 9

Primary Insertion site

Answer 9

Midclavicular, second intercostal space, riding the 3rd rib

Question 10

Secondary insertion site

Answer 10

Mid axillary 5th intercostal riding the sixth rib

Question 11

Thoracostomy management

Answer 11

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

Question 12

Complications of a thoracostomy

Answer 12

-failure to decompress
-bleeding
Pneumothorax
Infection

Question 13

What are the two pleural membranes

Answer 13

-visceral
-parietal

Question 14

What is a pleural effusion

Answer 14

The accumulation of pathological quantities of fluid in the intrapleural space

Question 15

What causes a pleural effusion

Answer 15

-liver and kidney failure
-CHF
-Infection
-Malignancy

Question 16

What is Empyema

Answer 16

Inflammatory fluid and debris within the intrapleural space. Usually results from an untreated bacterial pneumonia

Question 17

What causes empyema

Answer 17

-thoracic trauma
-rupture of lung abscess into the pleural space
Extension of mediastinal or abdominal infection
Iatrongenic at time of surgery

Question 18

Signs and symptoms of empyema

Answer 18

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

Question 19

Equipment needed for a chest tube

Answer 19

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

Question 20

What does 3 bottles with a chest tube mean

Answer 20

Valve + drainage +pull
-allows air in but not out
-rise and fall of fluid with breathing
-allows for collection
Creates negative pressure

Question 21

What does one bottle with a chest tube mean

Answer 21

Allows air out but not in
Rise and fall of fluid with breathing
Creates no suction
Not intended for collection

Question 22

What does the first chamber in the pleurovac unit do

Answer 22

Drainage

Question 23

What does the second chamber of the pleruovac do?

Answer 23

Water seal / one way valve

Question 24

What does the third chamber of the pleruovac do?

Answer 24

Suction chamber

Question 25

What are the two nevers

Answer 25

Never allow tubing to dangle
Ensure the collection unit never goes above chest level