chest tube cross
TRANSCRIPT
![Page 1: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/1.jpg)
Care Of Clients With Chest Tube
![Page 2: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/2.jpg)
DEFINITION
• Is a catheter that is inserted into the pleural cavity to reexpand the lung
![Page 3: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/3.jpg)
INDICATIONS
1.Traumatic pneumothorax2.Hemopneumothorax3.Spontaneous pneumothorax4. Latrogenic pneumothorax5.Bronchopleural fistula6. Emphysema7. Malignant8. Pleural effusion
![Page 4: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/4.jpg)
PURPOSE• 1. To permit drainage of air and fluid
from the pleural cavity• 2. To establish normal negative
pressure in the pleural cavity for lung expansion
• 3. To equalize pressure on both sides of the thoracic cavity
• 4. To provide continuous suction to prevent tension pneumothorax
![Page 5: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/5.jpg)
SITES FOR CHEST TUBE INSERTION
1. Thoracic surgery.• 2 chest tube inserted – Anterior chest
tube & Posterior chest tube
2. Anterior chest :• Upper/anterior chest wall• Inserted in the 2nd intercostal space
to remove the air arising from the pleural cavity
![Page 6: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/6.jpg)
CON’T
3.Posterior chest tube :• Placed at the posterior chest in the
8th or 9th intercostal space at the mid-axilllary line.
• Indication to remove serogeneous fluid at the lower area of pleural cavity
• Diameter of tube in the lower section is wider or longer compare to the upper tube.
![Page 7: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/7.jpg)
CON’T
4.Pneumothorax :• Tube placed at
the 2nd or 3rd intercostal space along midclavicle or anterior axillary line.
![Page 8: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/8.jpg)
TYPES OF CHEST DRAINAGE SYSTEM
Chest Drainage System
1 bottle 2 bottles 3 bottles Pleurovac
![Page 9: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/9.jpg)
TYPES OF SYSTEM - 1 BOTTLE DRAINAGE
![Page 10: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/10.jpg)
TYPES OF SYSTEM - 2 BOTTLE DRAINAGE
![Page 11: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/11.jpg)
TYPES OF SYSTEM - 3 BOTTLE DRAINAGE
![Page 12: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/12.jpg)
PLEUROVAC
![Page 13: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/13.jpg)
FUNCTION OF PLEURAL DRAINAGE SYSTEM
Inspiration
Intrapleural pressure
Air and fluid move into bottle
Pleural space becomes negative
Lungs reexpand
![Page 14: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/14.jpg)
PRINCIPLES OF THE CHEST TUBE
1. Gravity
2. Under Water Seal
3. Suction
![Page 15: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/15.jpg)
1. Gravity
• Enhances flow from high to low
• Chest drain is placed below client’s bed
![Page 16: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/16.jpg)
2. Water Seal
• Is a barrier to prevents backflow into pleural space.
• Rod – depth determines the negative pressure
• Air bubbles is released through the rod
• Air vent – to allow drained air to escape to prevent pressure build up
![Page 17: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/17.jpg)
3. Suction
• Is a pull force• MUST be in another bottle• Purpose for the suction when :- Gravity drainage is not enough.- Patient’s respiration and cough are
too weak- Air leak is fast into the pleural space- Need to speed up removal from
pleural space
![Page 18: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/18.jpg)
Nursing Responsibilities
1. Pre procedure.2. During3. Post procedure4. Emergency care
![Page 19: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/19.jpg)
Pre-procedure care
1. Confirm :• Open thoracotomy – during surgery• Closed thoracotomy – at patient’s
bedside.2. Inform patient3. Check for consent4. X-ray – with report to determine the
affected lung
![Page 20: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/20.jpg)
CON’T
5. Prepare equipments (Top shelf) :• T & S set that contains :- Swab cotton wool & gauze- Forceps, sponge holding forceps, dissecting,
toothed Holder, artery forceps, scissors, kidney dish, gallipot,sterile towel.
• Trocar and cannula set FG 33.• Syringe 20 cc,50cc,5cc• Needle – 21G,23G & 25G(2 each)• Suture – Mersilk size 0,2/0 reserve cutting.• Blade size 11
![Page 21: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/21.jpg)
CON’T
6. Prepare equipments (bottom shelf) :• Sterile glove depending dr size.• Mask• Connecting tubing & bottle drainage.• Cleansing lotion – alcohol 70% and povidone.• Op-site spray.• Sterile specimen bottle• Elastoplast• Counter scissors• Local anesthetic lignocaine 2% or 1%.• Low suction pump – if required• Clinical waste.• Regular waste bin
![Page 22: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/22.jpg)
CON’T
7. Position client :- Fowler’s
![Page 23: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/23.jpg)
Insertion of chest tube
![Page 24: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/24.jpg)
DURING – INSERTION OF CHEST TUBE
Procedure :1. Chest tubes can be inserted in the
ER, client’s bedside,or in OT2. In OT the chest tube is inserted via
the thoracotomy insertion.3. In ER, client’s bedside the client is
placed in the sitting position or is lying down with the affected side elevated
![Page 25: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/25.jpg)
CON’T
4. The area is prepared with antiseptic solution, and the site is infiltrated with a local anesthetic agent.
5. After a small incision is made, one or two chest tubes are inserted into the pleural space.
![Page 26: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/26.jpg)
CON’T
6. One catheter is placed anteriorly through the 2nd intercostal space; the other is placed posteriorly through the 8th or 10th space to drain fluid and blood.
7. The tubes are sutured to the chest wall, and the puncture wound is covered with an airtight dressing.
![Page 27: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/27.jpg)
CON’T
8. During insertion, the tubes are kept clamped
9. After the tubes are in place in the pleural space, they are connected to drainage tubing and pleural drainage and clamp is removed.
10. Each tube may be connected to a separate drainage system and suction.
![Page 28: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/28.jpg)
CON’T11. More commonly, a Y connecter is
used to attach both chest tubes to the same drainage system.
![Page 29: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/29.jpg)
DURING THE PROCEDURE – NURSING RESPONSIBILITIES
1. Observe respiration.2. Reduce anxiety3. Monitor saturation4. Prepare the under water seal5. Connect the closed system fast
![Page 30: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/30.jpg)
POST PROCEDURE CARE
1. Respiratory status :- Vital signs (15 min x 1 hour,30 mins x
1 hour,1 hr x 4 hours)- Respiration rate,pattern and rhythm- Color, chest pain, rapid pulse.- Check saturation- Administer oxygen when necessary.
![Page 31: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/31.jpg)
POST PROCEDURE CARE – RESPIRATORY STATUS
2. Auscultate :- Every 2 hours- Listen for breath sound- Listen for increased area of absent
breath sound- Place patient in flowler’s or high
fowler’s.
![Page 32: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/32.jpg)
POST PROCEDURE CARE – ANXIETY
• Due to fear of pain and complication.• Increase the need for oxygen• Explain to the patient – care of tube,
the fluid drained and frequent checks.
• Pay attention to their needs.• Allow relatives to stay.
![Page 33: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/33.jpg)
POST PROCEDURE CARE –WOUND STATUS
• Change the gauze when necessary
• Strict aseptic technique.
• Skin integrity – redness,swelling and loose suture
![Page 34: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/34.jpg)
POST PROCEDURE CARE –TUBING
1. Intact and taped
2. Maintain patency.- Check for obstruction
![Page 35: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/35.jpg)
CON’T
1. Teach the patient on how to care for the tubing.
- Place a pillow between patient and tubing.
- Instruct the patient to cough if tube is blocked
- Milking and stripping of the tube when blocked
![Page 36: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/36.jpg)
POST PROCEDURE CARE –CLAMPS
• Use rubber tips.• Clamped at the bedside.• Clamping :- During transfer- Not > 1 min- Upon doctor’s orders.
![Page 37: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/37.jpg)
POST PROCEDURE CARE –WATER SEAL
• Place below patient’s chest wall
• Fill with sterile water
• Rod must be immersed 2 cm in water
• Observe for the fluctuation of water level.
![Page 38: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/38.jpg)
CON’T
1. Fluctuation (tidaling)• To ensure patency of system.• Stops when :- Lung is fully expanded (36-72 hours)- When there is an obstruction• Check for obstruction.- Tubing – kinked- Patients position- Ask patient to take a deep breath and
cough
![Page 39: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/39.jpg)
CON’T
2. Observe for bubbling :- Intermittent bubbling is normal- Continuous bubbling is abnormal.- Check for• Wound• Tube• Connection- If rapid bubbling without air leak –
inform the doctor immediately
![Page 40: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/40.jpg)
CON’T3. Drainage output :
- 70 – 100 mls/hour
- Observe for change in drainage colour.- Mark the amount.• Mark the time of measurement and the fluid
level on the drainage chamber according to the prescribed orders
• Marking intervals may range from once per hour to every 8 hours.
• Any change in the quantity or characteristics of drainage ( eg. Clear yellow to bloody ) should be reported to Dr.
![Page 41: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/41.jpg)
CON’T
3. Drainage output (con’t)- Document in the I/O chart- Change bottle every 24 hours or
when full
![Page 42: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/42.jpg)
POST PROCEDURE CARE –SUCTION APPARATUS
1. Low suction pump :- Must be controlled- Suction valve / meter is inserted for wall
suction.- Check for bubbling.- If no bubbles :• Clamp the chest tube to check for air
leaks• Check the tubing and connection.• Observe patient’s condition while chest
tube is clamped
![Page 43: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/43.jpg)
POST PROCEDURE CARE –SAFETY
1. Tube :- Prevent kinking- Place a pillow as a barrier- Never clamp unnecessarily.- Assist patient during ambulation the
first time
![Page 44: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/44.jpg)
CON’T2. Bottle :- Bottles must be below chest level - Keep bottle in a basin - Inform relatives and housekeeping
regarding bottles- Bed must be locked- Activity should be limited to avoid
injury
![Page 45: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/45.jpg)
POST PROCEDURE CARE –AMBULATION
- Explain to client- Encourage change of position to
promote drainage.- Can sit up, get in and out of bed.- Stop the suction- No need to clamp the tube.- Maintain chest drain below chest
wall.
![Page 46: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/46.jpg)
POST PROCEDURE CARE –DEEP BREATHING AND ARM
EXERCISE
1. On the 1st post op day.
2. When patient is not in severe pain
3. Enhances lung expansion – expels air and fluid
![Page 47: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/47.jpg)
CON’T
4. Prevents stiffness of the arm
5. Assist patient .- Deep breathing exercise- Support when patient is coughing- Abdominal breathing
![Page 48: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/48.jpg)
POST PROCEDURE CARE - COMFORT
• Administer analgesic in the first 24 hours
• Allow position that is comfortable for the patient.
• Assist patient in providing self-care
![Page 49: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/49.jpg)
REMOVAL OF CHEST TUBE
• The chest tubes are removed when the lungs are reexpanded and fluid drainage.
• Assessment :• - X-ray is done to check the progress• - Clamp for 2 hours
• Chest tube is removed.
![Page 50: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/50.jpg)
EMERGENCY CARE
1. Bleeding Post Chest tube insertion :
- Observe wound dressing- Observe drainage- Inform the surgeon immediately
![Page 51: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/51.jpg)
CON’T
2. Dislodgement :- From insertion site – place a gauze
immediately over the wound
- From connection – clamp the chest tube immediately.
![Page 52: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/52.jpg)
CON’T
3. Bottle breaks :- Identify patient’s problem –
pneumothorax or hemothorax.- Observe patient fortension
pneumothorax - Place the tube in saline immediately.- Unclamp immediately – prevent
respiratory distress
![Page 53: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/53.jpg)
COMPLICATIONS
1. Bleeding
2. Pulmonary Embolus
3. Cardiac Tamponade
4. Atelectasis
![Page 54: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/54.jpg)
![Page 55: Chest tube cross](https://reader036.vdocuments.mx/reader036/viewer/2022081507/554b1686b4c9055d098b4cad/html5/thumbnails/55.jpg)