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CHEST TUBES

CHEST TUBES. Kelsey Bolt, Natasha Chelli, Katy Gaebler, Katelyn Herder, Mariam Opoku, Ian Saunders, Carli Simpson,. Question. What do the following patients have in common?. Mary. Jack. Sandy. Chris. Anatomy & Physiology. Lower respiratory tract. Layers of the pleura. Indications.

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CHEST TUBES

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  1. CHEST TUBES Kelsey Bolt, Natasha Chelli, Katy Gaebler, Katelyn Herder, Mariam Opoku, Ian Saunders, Carli Simpson,

  2. Question • What do the following patients have in common?

  3. Mary

  4. Jack

  5. Sandy

  6. Chris

  7. Anatomy & Physiology • Lower respiratory tract. • Layers of the pleura

  8. Indications • When Air (pneumothorax), blood (hemothorax), pus (pyothorax), or lymph (chylothorax) collect in the pleural cavity • Cardiac or thoracic surgery • Chest trauma • Administer therapy

  9. 3 Bottle System Tube open to atmosphere vents air Tube from patient Tube to vacuum source Straw under 20 cmH2O Fluid drainage 2cm fluid water seal Suction control Collection bottle

  10. Pleur-Evac • Closed system • Comes with 30ml syringe of sterile water • Suction dial • Suction indicator • Air leak meter • Collection chamber • Positive pressure relief valve • Filtered high negativity relief valve

  11. Preparation and Insertion • 4th or 5th intercostal space • Chest tube sizes • #26-40 Fr. for blood or viscous fluid • #18-22 Fr. for air ONLY • Pre and Post X-Ray • Baseline vitals including O2 saturation levels

  12. Gravity Drainage Suction Drainage • Attach tube to collection container • Add 30ml sterile water through injection port • YES or NO will appear on indicator • Attach to wall suction • 80-120 mmHg (usually set at 100mmHg) • Watch for orange float

  13. Heimlich One Way Valve • Allows for drainage and prevents re-entry of air into pleural space • Ideal for chronic pneumothroax or pleural effusion • Increased mobility for patients • Attached to a urinary collection bag

  14. Pediatric Considerations • Chest tube sizes • #16, 20 and 24 French • Small infants may require • #8-12 French • 3rd intercostals space at midaxillary line or 4th-5th intercostals space

  15. Complications • Dislodging - Small tubes vs. larger tubes. • Injury to internal organs - Know the point of Insertion • Pain - The pleura is very sensitive • Bleeding - Trauma to the intercostal arteries • Occlusion • Serious Harm and Death - Very low mortality rate. Death can occur

  16. Cause of Complications • Anatomical abnormality • To deep dilation • Failure to consider patients position • Failure to follow facility policy or procedure • Lack of knowledge • Poor imaging quality • Poor technique • Physical environment where inserted

  17. Nursing Management • Assess and monitor: • Tube patency • Dressing • Respiratory status • Cardiovascular status • ECG

  18. Nursing Management cont’d • Chest tube system • Patient positioning • Physician orders • chest x-ray, oxygen therapy

  19. Documentation • Date & Time, vitals, O2 sats, pre and post treatment • Tolerance to procedure • Characteristics and amounts of drainage • Amount of negative suction applied or if gravity drainage • Chest assessment

  20. Documentation (cont’d) • Type of dressing applied • On pleur-Evac and clinical fluid balance record • Amount of drainage q shift

  21. References • Charnock, Y., & Evans, D. (2001). Nursing management of chest drains: a systemic review. Australian Critical Care, 14(4), 156-160. Retrieved from www.cinahl.com/cgi-bin/refsvc?jid=555&accno=2002041166 • Durai, R., Hoque, H., & Davies, T. W. (2010). Managing a chest tube and drainage system. AORN Journal, 91(2), 275-283. Retrieved from www.cinahl.com/cgi-bin/refsvc?jid=121&accno=2010555154 • Roman, M., & Mercado, D. (2006). Review of chest tube use. MEDSURG Nursing, 15(1), 41-43. Retrieved from http://web.ebscohost.com.roxy.nipissingu.ca/ehost/pdfviewer/pdfviewer?vid=11&hid=10&sid=37fd6de3-08b7-424a-9e29-0eba0fffae04%40sessionmgr14 • Coughlin, A.M & Parchinsky, C. (2006). Go with the flow of chest tube therapy. Nursing, 36(3), 36-42. • Roman, M., & Mercado, D. (2006). Review of chest tube use. Medsurg Nursing, 15(1), 41-43. • Allibone, L. (2003). Nursing management of chest drains. Nursing Standard, 17(22), 45- 56. • National Institute of Health (2010). Chest tube insertion: Reasons and management. http://www.nlm.nih.gov/medlineplus/ency/article/002947.htm • Journal of Surgical Nurses: Nursing implications. http://surgnurseslinks.com/chest.chesttubes.htm • Nursing Considerations and Troubleshooting: http://www.teleflexmedical.com/ucd/nursing_considerations_troubleshooting.php http://www.health.vic.gov.au/__data/assets/pdf_file/0004/372109/chest_tube_management.pdf

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