chest tubes and drainage systems
DESCRIPTION
Chest Tubes and Drainage Systems. Deb Updegraff RN, CNS PICU LPCH. Chest Tubes Correct life threatening conditions caused by excess of fluid and/or air in the intrapleural space. Pneumothorax. A collection of air in the pleural space. Can occur with Central line placement - PowerPoint PPT PresentationTRANSCRIPT
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Chest Tubes and Drainage Systems
Deb Updegraff RN, CNSPICULPCH
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Chest Tubes
Correct life threatening conditionscaused by excess of fluid and/or air
in the intrapleural space
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Pneumothorax
A collection of air in the pleural space.
Can occur with• Central line placement• Chest surgery, • Trauma to the chest wall• Traumatic intubation• Mechanical ventilation
If air continues to collect in the chest, the pressure can rise and push the whole mediastinum over to the other side
Tension-Pneumothorax
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“Intra” pleural Space
There are 2 pleural membranes involved in respiration
• visceral pleura
• parietal pleura
The Parietal pleura lines the inside of the thoracic cavity. The visceral Pleura adheres to the outside of the lung.
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Pneumothorax
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Hemothorax
A collection of blood in the pleural space
Can occur with:
•Chest surgery•Central line placement•Chest trauma
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Hemothorax
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Pleural Effusion
The accumulation of pathologic quantities of fluid in the intrapleural space.
Maybe caused by:
• Liver and kidney failure• Congestive heart failure• Infection• Malignancy blocking the lymphatic system
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Empyema
Inflammatory fluid and debris within the intrapleural space. Usually results from an untreated bacterial pneumonia.
Other causes:• Thoracic trauma• Rupture of lung abscess into the pleural space• Extension of mediastinal or abdominal infection• Iatrogenic at time of thoracic surgery
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Patient Positioning Insertion Sites for Chest tubes
Pneumothorax: (AIR)• The best position is supine or with head elevated anywhere from low to high fowler’s.• The chest tube will be inserted into the 2nd or 3rd intercostal space anterior chest at the mid-clavicular line
Effusions: (FLUID)• If patient able, best position is sitting on the side of the bed leaning over a pillow placed on a bedside table.• The chest tube is inserted between the 4th to 6th intercostal space mid-axillary line
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Insertion sites
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How 3 chamber drainage system works
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First Chamber
The Water Seal chamber
Fresh chest tube inserted, patient could suck air directly into chest.The distal end must be controlled. The water seal chamber acts asA one way valve. Air can get out and as long as the tube is longEnough, water can not be sucked in. Bubbles moving throughThis chamber means the patient has an air leak.
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Second Chamber
2 1
Single chambers are fine if all you want to drain in air.When there is fluid it’s time for a second chamber.
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Third Chamber
Here’s an idea! What if the fluid is thick or just needs extra help to drain?What if we could add suction? Time for a 3rd chamber.
12 3
1 water seal chamber2 drainage chamber3 suction chamber
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1 23
1 Water seal chamber2 Drainage chamber3 Suction Chamber
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Third Chamber –Suction Chamber
The strength of suction is directly affected by thelevel of water. The MD will order this. In Pediatricsthe amount is usually 15cm.
You need regulated wall suction. The weight of the water acts as the suction limiter. No matter howHard the wall suctions pulls, the actual suction delivered tothe patient is 15cm.
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Now back to Air Leaks
First Chamber-Water seal chamber
This chamber shows an air leak. This is a Good thing if you have just placed the tubeFor a pneumothorax. It means the air is Getting out of the patient.
This does not automatically mean that air is Coming out of the chest.
The leak can be coming from anywhere in theSystem and this can be bad.
1
1
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If the chest tube is pulled and dislodged, the drainage holes can actually be “outside of the patient” sucking air. Air can dangerously accumulate.
In addition to the bubbles in the air leak chamber you should be able to hear this with a stethoscope.
What to do:• Take dressing down wrap hole with Vaseline gauze• Call for a stat CXR.
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Clamping a Chest tube
• Clamping a chest tube is a very big deal
Only clamp if you are:
Changing a full pleurovac
Or if you are
Trying to determine if the system is leaking.
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Water Seal
• Usually this is ordered when the air/fluid draining from the patient is assumed to be pretty much over and done with.
• What carefully for signs of re-accumulation
It means to disconnect from wall suction