Chest Tubes….Just Another Drain

(Yeah right)

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 ______

_______.

How We Breathe….

On inspiration, the lungs move downward.

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

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.

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

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 _________.

Types of Drainage Systems

Glass Bottle System:1 bottle2 bottle3 bottle

Plastic System:ThorasealPleuravac

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.

Question????

How would the waterseal help in restoring negative intrathoracic pressure??

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?

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

Care of the Patient with a Chest Tube

Atrium Chest Drainage System

Now Let’s Meet The Patient…..

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?

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?

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.

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

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.

Any Questions???

The End…….