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Chest Tubes: removes air or fluid to expand lung - Coggle Diagram
Chest Tubes:
removes air or fluid to expand lung
inserted into pleural space between parietal (outter) and visceral (inner) pleura
Reasons for tubes:
Pneumothorax, pleural effusion (hemothorax, empyema, chylothorax), cardiac surgery (place mediastinal tube under sternum)
Dry Suction:
No water, dial in desired pressure (-20 cm of water), must vent when decreasing pressure, can give increased suction options, no water evaporatoin
Flutter (Heimlich) Valve
Only opens when thoracic pressure is higher than atmospheric, used for emergency transport and small/moderate pneumothorax, increases patient mobility; MUST VENT ANY ATTACHED DRAINAGE BAG to prevent tension pneumothorax (cut small slit at the top); Patients may go home with this in place
Troubleshooting:
If chest tube falls out: cover site with sterile dressing and tape on 3 sides (vent dressing) and notify the physician immediately
If system breaks, order a new one put tubing in 1 inch of sterile water to maintain water seal
If unit overturned- have patient exhale and cough. NEVER CLAMP WITHOUT PHYSICIANS ORDER or milk/strip the tubing
Wet Suction
: Amount of water in the chamber controls suction to the lungs, typically filled to -20 cm of water, adjust suction until gentle bubbling in third chamber; excess suction is vented; monitor for water evaporation and refill to prescribed amount; you will hear and see gentle bubbling
Tube from patient drains into
drainage chamber
;
water seal chamber
(blue) moves up and down with breathing (tidaling)(some bubbles seen initially):
Air leak monitor
(below water seal chamber) where we watch for bubbles;
suction control
differs in each system but
a
Chest tube placement
: Done in ED, OR, or bed side. Patient positioned with arm above head and body is at 30-60 degrees. Probed digitally after a slit is made. Place tube up over the rib and sutured into place, wound is covered with occlusive dressing
WHAT ARE WE LOOKING FOR
: Look for bubbling in air leak monitor (excessive/continuous is not good); if water in water seal chamber is not tidaling with breathing there could be a kink in the tubing or the problem has resolved and lung is reinflated; drainage should not exceed 100 mL per hr;
Nursing interventions
: Monitor respiratory status, breathing (any dyspnea?), vitals, look at insertion site, monitor for crepitis (rice crispies); have them cough and deep breathe; ROM exercises; reposition patient; monitor drainage system (system including tubing should be kept below the patients chest)
Assisting with removal
:
When lungs reexpand and drainage is minimal
Premedicate 30-60 min prior
Valsalva maneuver during removal
Semi-Fowlers position
Monitor respiratory status and for distress
Chest XRAY done after (30-60 min after)
Should heal in 2-3 days
Gather supplies for physician: sterile gloves, dressing of choice, suture removal kit
Notify physician if:
drainage > 200 mL, crepitis (subcutaneous emphysema) or respiratory distress happen within the first hour