Download - CHEST TUBE THORACOSTOMY.pptx
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THORACOS
TOMYJill Catherine Cabana
Anna Patricia Santua
BSN4
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DEFINITION is a surgical opening in the chest wall
and inserting a thoracostomy tube
(chest catheter) is inserted into the
chest wall above the area of the secondor third rib. A local anesthetic (xylocaine
1% or 2%) is administered and an
incision is then made into the pleural
space of the chest wall. The tube isinserted, positioned, and clamped, and
silk sutures are use to secure the chest
tube in place.
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PURPOSESPurposes:
-Remove excess air, blood, or fluid from the pleural cavity,
-Reduce the size of the pleural space, and restore
negative intrapleural pressure to promote lungexpansion.
-Remove tumors of the lung, bronchus or chest wall
-Repair or reverse structures contained in the thorax such
as open heart surgery or repair of a thoracic aneurysm.-Repair trauma to the chest or chest wall, such as
penetrating chest wounds or crushing chest injuries.
-Sample a lesion for biopsy.
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INDICATIONS Surgery
Traumatic chest injuries
Pneumothorax Hemothorax
Pleural effusion (build up of fluid
between the pleura)
Infection (empyema)
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DRAINAGE-known as the water seal drainage.
-use to restore the negative pressure that has been lost
inside the pleural space owing to pneumothorax, and to
prevent additional air and fluid from entering the pleural
cavity. The chest tube leads from the chest via plastic or
rubber tubing to a glass container in which the end of the
tube is attached to a glass rod submerged in water. An air
vent allows the escape of air, which bubbles up through the
water. This constitutes the water seal which prevents airfrom traveling up to the tube to the pleural space in which
negative pressure must develop to re-expand lung.
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system (Valve)
It provides water-seal gravity drainage. The gravitysystem allows the flow of air or water into the bottle when
the pressure in the pleural space is sufficient to displace
the water in the glass rod. The long glass rod is
submerged about 2 cm below the water surface; anintrapleural pressure greater than 2 cm in the pleural
space will be required to displace it.
Since the gravity water-seal drainage bottle is covered
with a stopper, the short glass rod simply serves to allowthe escape of air from the bottle. If this short glass rod
becomes occluded, air pressure could build up within the
bottle. This increase pressure pushes the water in the
bottle up the long glass tube toward the chest, risking
back flow of fluid into the chest.
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seal drainage system
(Valve+ Drainage) It involves the addition of a suction source and a suction-
control bottle. It is added if gravity is not sufficient to clear
the air or fluid from the chest. The suction-control bottle
allows the entrance of air which bubbles through the column
of water in the glass rod, reducing the amount of negativepressure from the suction source. This is sometimes called
a suction-breaking bottle.
When the force of suction exceeds that required to displace
the water inside the glass rod, from the water level down tothe end of the glass rod, room air will be drawn into the
system to reduce the negative pressure applied to the chest.
Failure of the breaker bottle to bubble means that the
desired amount of suction has not been reached.
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Water Seal
(Valve)
Drainage
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-system 3 Bottles=Valve + Drainage + Pull
It involves the addition of a separate collection
bottle so that the drainage may be separatecollection bottle so that drainage may be
measured and inspected as it comes from the
chest.
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Pleur-evac It is a commercially available product incorporating all
the features all ready discussed. It is a single light
weight unit which indicates the amount of air bubbling
through the suction chamber from the atmosphere. It
calibrates the exact amount of negative pressure in thepleural space and has a client leak air flow meter to
indicate the amount of air coming from the individual
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Responsibilities ASSESSMENT
Patency/functioning of system (kinks, clamps,atrium, suction, etc)
Dressings
Quantity and quality of drainage
Dependency of collection system
Coiled tubing, not hanging tubing
Pain control
Respiratory status and Vital signs
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Responsibilities ASSESSMENT
Note specific orders regarding:
Suction versus water seal
Amount of acceptable drainage
I & O
X-rays
Administer pain medications regularly
Patient should change positions frequently
(promotes drainage, prevents complications)
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