Chest Tubes….Just Another Drain

1. Chest Tubes….Just Another Drain (Yeah right)

2. Caring for a Patient with a Chest Tube • Let’s review some A & P • The lungs are wrapped by a double sided envelope of tissue called the _________. • The inner most layer is called the _____ _______. • The outer most layer is called the ______ _______.

3. How We Breathe…. On inspiration, the lungs move downward.

4. The visceral and parietal pleura are separated by a thin film of ________. On inspiration, the chest wall expands and the diaphragm moves _________. During inspiration, the pressure within the thoracic cavity is < or > atmosp. pressure so air can rush in the lungs

5. During expiration, the intrathoracic pressure is > or < allowing air to exit the lungs. • If air or blood is introduced into the pleural space, the normal pressures are disrupted and the lung or lungs will collapse. • To drain this air and/or fluid off the pleural space, a chest tube is NEEDED.

6. Indications for Chest Tube Insertion • Pneumothorax: Presence of air in the pleural space • Hemothorax: Presence of blood in the pleural space • Hemopneumothorax: Presence of air and blood in the pleural space

7. Chest Tube Insertion • Pneumothorax: Chest tube will be placed at 2nd intercostal space since air ______. • Hemothorax: Chest tube will be placed in the 5th/6th or 8th/9th intercostal space since blood and fluid _________.

9. Types of Drainage Systems Glass Bottle System: 1 bottle 2 bottle 3 bottle Plastic System: Thoraseal Pleuravac

11. Principles of Chest Tube Functioning • The idea is to create a one way mechanism that will let air out of the pleural space and prevent outside air from coming in….why would this be a problem? • This is accomplished by the use of an underwater seal. The distal end of the drainage tube is submerged in 2cm of H2O.

12. Question???? • How would the waterseal help in restoring negative intrathoracic pressure??

13. To Clamp or Not to Clamp???? • What would happen if the chest tube exiting the patient’s chest became kinked or clamped???? • Would it make a difference if it was a pneumo vs a hemothorax?

15. Tension Pneumothorax…Paging Dr. Carter • Trachea is deviated • Decreased or absent breath sounds on affected side • Blood pressure drops • Tachycardia • Dyspnea, Hypoxia, Hypoxemia • Decreased Cardiac Output

16. Care of the Patient with a Chest Tube

18. Atrium Chest Drainage System

19. Now Let’s Meet The Patient…..

23. Open Pneumothorax • Air enters the pleural space through an actual opening in the chest wall. Can you name some examples of how an open pneumo can occur?

24. Closed Pneumothorax • Air enters the pleural space without any external wound…..originates from within. Can you name some examples which would cause a closed pneumo?

25. Nursing Responsibilities/Care of Patient with Chest Tube • Keep drainage system 2-3 feet below patient’s chest • Keep tubing patent; make sure no kinks or clots present • Observe and record amount of drainage. >100cc/hr is heavy…notify physician. • Encourage TCDB, ambulation as ordered.

26. When a patient has a chest tube to gravity drainage, the nurse should: • A. Position the patient on his back • B. Restrict the patient of bedrest • C. Provide long tubing to reach the suction source • D. Keep the drainage chamber below chest level

27. The nurse knows to clamp the chest tube if: • A. The drainage unit is disrupted or broken. • B. The patient develops a tension pneumothorax. • C. Locating a source of an air leak. • D. The patient must be transported.

28. Any Questions???

29. The End…….