Transcript chest tubes
CHEST TUBES Chest tubes Indications – Pleural effusions Hydrothorax Chylothorax Hemothorax Empyema – Pneumothorax Pleural Effusions Fluid in the pleural space Two types – Transudative – Exudative Pleural Effusions Transudative – Accumulation of fluid when the integrity of the pleural space is intact – Less protein and inflammatory cells – Hydrostatic and osmotic pressures are abnormal Pleural Effusions Exudative – Inflammation of the lung or pleura – More protein and inflammatory cells – Types Hemothorax Chylothorax Pleural Effusion Exudative – Causes Neoplastic disease Infectious disease PE GI disease Drugs http://images.google.com/imgres?imgurl=http://radpod.org/wpcontent/uploads/2006/11/c_hernia_1.jpg&imgrefurl=http://www.radpod.org/2006/11/29/incidental-diaphragmatichernia/&h=898&w=972&sz=170&hl=en&start=4&tbnid=jXOADRpIamp8XM:&tbnh=138&tbnw=149&prev=/images%3Fq%3Dpleural%2Beff usion%2Bdrain%26gbv%3D2%26hl%3Den http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijtcvs/vol6n2/cystic.xml Pneumothorax Air in the pleural space Can be – Traumatic – Spontaneous – Tension http://www.faqs.org/health/Sick-V3/Pneumothorax.html Chest tubes Small bore – 7 French shown What is the size range for children and adults? – Heimlich valve – Used for pneumothorax mostly Chest tube Insertion – 2nd or 3rd intercostal space – Midclavicular level Chest Tube Large bore – Up to 40 French – For pleural effusions and pneumothorax – Use local anesthetic and dissect to the parietal pleura – Finger sized hole Chest Tube Large Bore – Insertion 4th to 6th intercostal space Midaxillary line – Suture into place, use petroleum gauze – Get x-ray – Hook to drainage system Drainage systems Gravity – Affects air and fluid Positive pressure – Increased positive pressure from the air or fluid will try to relieve itself to lower pressure Suction – Sub-atmospheric pressure Drainage systems One bottle system – Contains 100ml of sterile water Airtight cap Two vent tubes Drainage systems Two bottle system – 1st bottle = drainage – 2nd bottle = water seal Drainage systems Three bottle system – 1st bottle = drainage – 2nd bottle = water seal – 3rd bottle = suction Drainage systems Trouble shooting – Excessive bubbling Leak in system – No bubbling Re-expansion or occlusion – Milk the tubes…maybe Drainage systems Pleur-evac – Three bottle concept in one lightweight, plastic unit – Easy to transport – Difficult to break – Easy to exchange when full – Will hold up to 2500 mL of fluid Drain systems Pleur-evac – Right side – calibrated for measurement of fluid evacuation – Middle – water seal chamber – Left side – suction control Chest tube removal Requirements – No air leak – < 100 mL drained in 12 - 24 hours – Stable respiratory status What constitutes stable?? Chest tube removal Patient in semi-fowlers Premedicate D/C suction, clamp tube Prep 4x4 gauze of Jelonet and elastoplast tape Chest tube removal Remove current dressing and remove sutures Clean site with antiseptic solution Patient deep breath, pull out Should come out easily!!!!!! Secure site with the gauze and elastoplast Chest tube removal Watch patient for signs/symptoms of respiratory distress Get chest x-ray