Transcript Chest Tubes

Chest Tubes
Charlotte Cooper RN, MSN, CNS
Thoracic Cavity
• Lungs
• Mediastinum
– Heart
– Aorta and great
vessels
– Esophagus
– Trachea
Breathing: Inspiration
• Diaphragm contracts
• Moves down
• Increasing the volume of the
thoracic cavity
• When the volume increases, the
pressure inside ________.
• Pressure within the lungs is called
intrapulmonary pressure
Breathing: Exhalation
• Phrenic nerve stimulus stops
• Diaphragm relaxes
• This ______ the volume of the
thoracic cavity
• Lung volume decreases,
intrapulmonary pressure _____
• Atmospheric pressure
Pleural Anatomy
– Parietal pleura
– lines the chest wall
– Visceral pleura (pulmonary)
– covers the lung
Pleural Anatomy
Visceral pleura
Parietal pleura
Lung
Intercostal
muscles
Ribs
Normal Pleural Fluid Quantity:
Approx. 25mL per lung
Pleural Physiology
• Area between pleura
• “potential space”
• Normally, negative pressure between pleura
• During inspiration, the intrapleural pressure is approximately 8cmH20
• During exhalation, intrapleural pressure is approximately 4cmH20
What happened?
What is this?
What is this?
Flail Chest
Pleural Injury
• Blood in pleural space
• Caused by
• Like pneumothorax
• Manifestations
Pleural Injury:
Therapeutic Interventions
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Diagnostic tests
Client position
Treatment depends on severity
Chest tube
Heimlich valve on chest tube
Chest Tube Placement
Heimlich Valve
Prevent air & fluid from returning to the
pleural space
Chest tube is attached to a drainage device
– Allows air and fluid to leave the chest
– Contains a one-way valve to prevent air & fluid
returning to the chest
– Designed so that the device is below the level of
the chest tube for gravity drainage
– What happens if you clamp the chest tube?
Treatment goal for pleural injuries
1. Remove fluid & air as promptly as possible
2. Prevent drained air & fluid from returning to
the pleural space
3. Restore negative pressure in the pleural space
to re-expand the lung
Interventions
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Dressing changes
No dependent loops
Oxygen therapy
Analgesics
IS and turn, cough, deep breathe
Nursing assessment and pertinent nursing
problems/interventions
• Health history-respiratory disease, injury, smoking,
progression of symptoms
• Physical exam- degree of apparent resp distress, lung sounds,
O2 sat, VS, LOC, neck vein distention, position of trachea
• All require observation for lung symptoms
• Pertinent nursing problems
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Acute pain
Ineffective airway clearance
Impaired gas exchange
Home care
Prevent Air and Fluid Backflow
Tube open to
atmosphere
vents air
Tube from patient
Prevent Air and fluid backflow
• For drainage, a second
bottle was added
• The first bottle collects the
drainage
• The second bottle is the
water seal
• With an extra bottle for
drainage, the water seal will
then remain at 2cm
Restore negative pressure in the
pleural space
The depth of the water in
the suction bottle
determines the amount
of negative pressure
that can be transmitted
to the chest, NOT the
reading on the vacuum
regulator
How a chest drainage system works
• Expiratory positive pressure
• Gravity
• Suction
Chest Tube Set Up
• Stop cock control
• Placement of unit
• Disposal
• Air leaks
Assessment
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Focused respiratory assessment
Breath sounds
Respiratory rate
Respiratory depth
Chest excursion
SpO2
ABG
CXR
Assessment
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Respiratory assessment
Heart rate
Level of consciousness
Pain
Chest tube
If chest tube comes out?
Pleural Effusion
Pleural effusion- S & S and therapeutic
interventions
• Common manifestations
• Diagnostic tests
• Treatment
Mediastinal shift
• Mediastinal shift
• High pressure
• Displaced to unaffected side
• Structures compressed
• External pressure
• Decrease blood flow
Review
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Check fluid level in suction chamber
Observe water seal chamber fluid level
Assess for tidaling in water seal chamber
Assess for tubing – non dependent
Determine if the unit been knocked over
Note the amount, color and consistency of drainage
Above all
What is most important?
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Monitor your client
Notify MD STAT if
Significant drainage
Increasing shortness of breath
Pain
Absence of breath sounds
Management
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Do not remove suction without an order
Manage pain
When full place in biohazard container
Do not change collection device on client with
an air leak without an order
• When suction discontinued, must disconnect
from suction, not just turn off