chest tube toracotomy 1
DESCRIPTION
chest tubeTRANSCRIPT
![Page 1: Chest Tube Toracotomy 1](https://reader033.vdocument.in/reader033/viewer/2022061606/5695d3b61a28ab9b029ee490/html5/thumbnails/1.jpg)
EKO PRESTIYANA MEGAWATII11111057SMF ILMU BEDAH RSAA SINGKAWANG
TUBE TORACOSTOMY (CHEST TUBE)
![Page 2: Chest Tube Toracotomy 1](https://reader033.vdocument.in/reader033/viewer/2022061606/5695d3b61a28ab9b029ee490/html5/thumbnails/2.jpg)
Anatomi
Costae I-VII Otot:
M. Intercostalis eksterna M. Intercostalis interna M. Seratus anterior
Arteri, Vena, Nervus intercotalis posterior Pleura: Parietal pd dinding dada, visceral meliputi
paru-paru Cairan pleura normal 0,01 ml/KgBB/jam Tekanan rongga pleura ketika tidak ekspirasi -5
s/d -7,5 cmH2O
![Page 3: Chest Tube Toracotomy 1](https://reader033.vdocument.in/reader033/viewer/2022061606/5695d3b61a28ab9b029ee490/html5/thumbnails/3.jpg)
Definisi
Tube thoracostomy adalah prosedur memasukkan sebuah selang (selang pada dada) ke kavitas pleura untuk mengeluarkan: Air Blood Bile Pus Other fluidRe-ekspansi paru-paru secepatnya
![Page 4: Chest Tube Toracotomy 1](https://reader033.vdocument.in/reader033/viewer/2022061606/5695d3b61a28ab9b029ee490/html5/thumbnails/4.jpg)
Indikasi
Pneumothorax Tension Spontaneous Iatrogenic consider while on mechanical ventilation
Hemothorax Hemopneumothorax Empyema Chylothorax Efusi Pleura
![Page 5: Chest Tube Toracotomy 1](https://reader033.vdocument.in/reader033/viewer/2022061606/5695d3b61a28ab9b029ee490/html5/thumbnails/5.jpg)
Pneumothoraks
Tertampungnya udara di dalam kavum pleura.
Spontaneous: Primer (Subpleural bleb ruptur), Sekunder (Pneumonia with lung abcess, lung cancer), Neonatal
Acquired: Iatrogenic, Barotrauma, Traumatic (Blunt trauma, penetrating trauma)
![Page 6: Chest Tube Toracotomy 1](https://reader033.vdocument.in/reader033/viewer/2022061606/5695d3b61a28ab9b029ee490/html5/thumbnails/6.jpg)
![Page 7: Chest Tube Toracotomy 1](https://reader033.vdocument.in/reader033/viewer/2022061606/5695d3b61a28ab9b029ee490/html5/thumbnails/7.jpg)
Efusi Pleura
Akumulasi abnormal dari cairan pleura, sebagai akibat dari kerusakan kontrol aliran cairan, masuk dan keluar dari dan ke cavum pleura, serta oleh akibat dari trauma.
Eksudat, disebabkan malignansi, penyakit TB, pneumonia
Gejala: Nyeri dada Batuk Sesak napas
![Page 8: Chest Tube Toracotomy 1](https://reader033.vdocument.in/reader033/viewer/2022061606/5695d3b61a28ab9b029ee490/html5/thumbnails/8.jpg)
Hematothorax
Penumpulan sudut costophrenicus sudah menjadi indikasi pemasangan chest tube
![Page 9: Chest Tube Toracotomy 1](https://reader033.vdocument.in/reader033/viewer/2022061606/5695d3b61a28ab9b029ee490/html5/thumbnails/9.jpg)
Chylothorax
Akumulasi cairan limph (chyle) dalam rongga pleura -> kebocoran thoracic duct atau salah satu pembuluh limphatik dalam rongga pleura
Penyebab: lumphoma dan trauma setelah operasi thorax
![Page 10: Chest Tube Toracotomy 1](https://reader033.vdocument.in/reader033/viewer/2022061606/5695d3b61a28ab9b029ee490/html5/thumbnails/10.jpg)
Empyema
Akumulasi pus di rongga pleura yang biasanya disebabkan sekunder karena infeksi paru.
![Page 11: Chest Tube Toracotomy 1](https://reader033.vdocument.in/reader033/viewer/2022061606/5695d3b61a28ab9b029ee490/html5/thumbnails/11.jpg)
Tatalaksana
Keluarkan cairan/udara sesegera mungkin
Cegah cairan atau udara yang keluar kembali masuk rongga thorax
Usaha mengembalikan tekanan negatif di rongga pleura, sehingga paru bisa berkembang sempurna.
![Page 12: Chest Tube Toracotomy 1](https://reader033.vdocument.in/reader033/viewer/2022061606/5695d3b61a28ab9b029ee490/html5/thumbnails/12.jpg)
KontraIndikasi
Tidak ada kontraindikasi mutlak Kontraindikasi relatif:
Adanya penyakit kelainan pembekuan darah
Infeksi pada daerah pemasangan Dinding dada tidak dapat diakses (Misal
tumor)
![Page 13: Chest Tube Toracotomy 1](https://reader033.vdocument.in/reader033/viewer/2022061606/5695d3b61a28ab9b029ee490/html5/thumbnails/13.jpg)
Pemasangan Chest Tube
WSD (Water Sealed Drainage)Cavitas Pleura
Collection
Water Seal
Suction
Control
To Suction
Collection
Suction
Control
To Suction
Prinsip1. Gravitasi2. Tekanan negatif3. Suction4. Water sealed
![Page 14: Chest Tube Toracotomy 1](https://reader033.vdocument.in/reader033/viewer/2022061606/5695d3b61a28ab9b029ee490/html5/thumbnails/14.jpg)
Pembuatan WSD Manual
Botol aminofluid NGT No. 18 Kayu untuk fiksasi Badan spuit 1 cc Air NaCl di isi 1/5
dicampur sedikit betadin
Bisturi untuk memotong ujung botol
Plester untuk fiksasi udara yg keluar
![Page 15: Chest Tube Toracotomy 1](https://reader033.vdocument.in/reader033/viewer/2022061606/5695d3b61a28ab9b029ee490/html5/thumbnails/15.jpg)
Alat dan Bahan
Handscoen steril Lidokain dalam spuit 5cc Kassa Povidon dalam mangkuk Bisturi dan Handle
bisturi Klem, klem musquito Pinset anatomis dan
chirurgis Gunting jaringan dan
gunting benang Thoracic trocer kateter Jarum dan benang silk Hypafix
![Page 16: Chest Tube Toracotomy 1](https://reader033.vdocument.in/reader033/viewer/2022061606/5695d3b61a28ab9b029ee490/html5/thumbnails/16.jpg)
Pemasangan Chest Tube
British Thoracic Society: Triangle of safety: lateral border pectoralis major, anterior border latissimus dorsi, ICS V-VI
Posisi supine atau 45°, lengan abduksi dan eksternal rotasi.
ATLS: Location of CTT: ICS 5-6,
midaxillary line Chest tube size 24 or
28 F
![Page 17: Chest Tube Toracotomy 1](https://reader033.vdocument.in/reader033/viewer/2022061606/5695d3b61a28ab9b029ee490/html5/thumbnails/17.jpg)
Komplikasi
Acute Reexpansion
pulmonary edema Hemothorax Lung laceration Diafragma/abdominal
cavity penetration Subcutaneous
emphysema Pneumothorax Nyeri
Late Blocked tube Empyema Pneumothorax
after removal Infeksi Retained
hemothorax
![Page 18: Chest Tube Toracotomy 1](https://reader033.vdocument.in/reader033/viewer/2022061606/5695d3b61a28ab9b029ee490/html5/thumbnails/18.jpg)
Remove Chest Tube
Tekanan rongga pleura (-) Paru-paru sudang mengembang -> Ro.
thorax Fistel negatif -> tidak ada bubble Selang tidak tersumbat Produksi kualitatif dan kuantitatif
minimal (<100cc/24jam) Pasca remove chest tube -> Ro thorax
control Klinis -> RR (normal)
![Page 19: Chest Tube Toracotomy 1](https://reader033.vdocument.in/reader033/viewer/2022061606/5695d3b61a28ab9b029ee490/html5/thumbnails/19.jpg)
TERIMAKASIH