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									Fundamentals of Primary
Health Care B



 Tracheostomy
 Suctioning
 Chest Tube
 Feb. 28, 2009
 2nd Semester A.Y. 2008-2009
TRACHEOSTOMY
TRACHEOSTOMY – A surgical incision in the
  trachea just below the larynx .
 - maybe done under emergency conditions , but it
  is ideally performed in the operating room / to
  establish an airway
 - the universal or standard of a tracheostomy
  tube consist of an outer cannula , an inner
  cannula and an obturator .
 - other types of tracheostomy includes the
  following : fenestrated / non fenestrated/ talking
  tracheostomy / permanent
a. Obturator – is inserted into the tube to guide
   the outer cannula during initial placement . It
   is kept at the bedside in case the outer
   cannula or a new one needs to be reinserted
   . ( obturator / kelly @ bedside for emergency)
b. Outer cannula – is the “main shaft” that is
   inserted into the trachea . It has a flange (
   neck plate ) at the external opening of the
   tracheostomy stoma . Tape or cloth is tied
   through the flange and around the client’s
   neck to hold the outer cannula in place
c. Inner cannula – fits into the outer cannula;
   the inner cannula is removed for cleaning ,
   while the outer cannula remains in place .
UNCUFFED TUBE – maybe plastic or metal
 which allows air to flow around the tube /
 person with permanent tracheostomy may
 use an uncuffed tube .
CUFFED TUBE – are surrounded by
 inflatable cuff that produces an airtight seal
 between the tube and trachea / use
 immediately after tracheostomy / client
 ventilating with mechanical ventilator
Note – children do not require cuff tubes
 because their tracheas are resilient enough
 to seal the air space around the tube .
Metal Trache
FENESTRATED TRACHE TUBE – has holes in
  the outer cannula
    > the inner cannula is in place when the
  patient is on mechanical ventilator .
    > when the client is being WEANED (gradual
  discontinuation of mechanical support )
        - inner cannula is removed
        - cuff deflated
        - external opening of the tube is plugged
– client can now breathe around the
  tube and through the fenestration
  and also talk . When the client tires
  and needs to return to using the
  ventilator the nurse can easily do
  this by inserting the inner cannula
  (which occludes the fenestration ) ,
  inflate the cuff unplugged the tube
  and attach the ventilator .
INDICATIONS FOR A TRACHEOSTOMY
1.To maintain a patent airway .
2.To remove secretions especially when the
  client is unable to do so by coughing
  independently .
3.In the presence of head and neck burns or
  suspected laryngeal edema
4.Following surgical procedures .
5.Following irradiation procedures .
INDICATIONS FOR A
TRACHEOSTOMY
 6. Removal of foreign body .
 7. Intolerance to endotracheal tube or when
     endotracheal tube is in place for more than a
     week
 8. Neurological disorders involving diaphragm ,
     thoracic cavity , difficulty in swallowing ,
     paralysis .
 9. Apnea or unconciousness .
 10. Respiratory failure .
 FOR DISCUSSION
  TODAY!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
  !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
  !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
  !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
  !!!!!!!!!!!!!!!!!!!!!!!!!
ADVANTAGES :
1.Improved client comfort
2.Decrease tracheal , pharyngeal , oral,
  nasal damage caused by long term E.T
  placement .
3.Use of nasoenteric tubes for nutrition may
  not be necessary , client can swallow
  effectively .
4.Oral secretions management improved
5.Adaptive devices > client able to speak
GOALS OF COLLABORATIVE MANAGEMENT
  INCLUDE :
 Reestablishing and maintaining a patent airway
 Preventing dislodgement of the tracheostomy
  tube after insertion .
 Providing long term mechanical ventilation .
 Providing adequate nutrition and hydration .
 Helping the client to communicate .
GOALS OF COLLABORATIVE
MANAGEMENT INCLUDE :

 Preventing injury .
 Preventing bacterial contamination of the
  airway during suctioning .
 Preventing respiratory and cardiovascular
  complications from suctioning .
 Teaching client and family on how to take care
  for the tracheostomy at home if necessary .
IMPORTANT NURSING DIAGNOSES
  (ACTUAL / POTENTIAL) ARE :
 Impaired gas exchange
 Ineffective airway clearance
 Ineffective breathing pattern

 Risk for injury – accidental extubation
 Risk for infection
 Impaired swallowing
Impaired nutrition , less than body
 requirements
Impaired verbal communication – (paper
 and pencil / magic slate / prepare list of
 needs e.g urinal , bedpan , pain
 medication etc. )
Constipation and other bowel dysfunction
 – ( valsalvas maneuver is not performed /
 glottis closed – vocal cords bypass )
Body image disturbance
Anxiety and fear
Ineffective management of therapeutic
 programs
RISK FACTORS

Tracheostomy is necessary when the
  airway is obstructed due to :
Aspiration of foreign object or stomach
  contents
upper airway bleeding
cancer of the larynx
tracheal tumors or strictures
Tracheostomy is necessary when the airway
  is obstructed due to :

enlarge thyroid
oropharyngeal tumor
excess mucous in airway
vocal paralysis
laryngeal edema
epiglottitis
severe obstructive sleep apnea
need for continuous mechanical ventilation .
SIGNS AND SYMPTOMS FOR NECESSITATING
  TRACHEOSTOMY
 Choking
 Loud snoring inspirations due to partial
  obstruction
 Stridor
 Decreased or absent phonation
 Ineffective cough
 Wet gurgling noise due to excess mucous
 Diminished breathe sounds
 Difficulty of swallowing
 Severe dyspnea
 Tachypnea
 Restlessness / fear / anxiety and cyanosis
DIAGNOSTIC AND LABORATORY TEST
1. Fiberoptic bronchoscopy
2. Chest x – ray
3. ABG values
4. Pulse oximetry
5. Diagnostic test for specific tumors (
   thyroid / laryngeal , oropharyngeal ,
   mediastinal)
THERAPEUTIC NURSING MANAGEMENT :
1. Prevention of complications from tracheostomy
   a. properly secure trache tube
   b. do not over inflate the cuff
   c. do not allow the tracheostomy tube to become
    occluded with excessive or dried secretions
   d. use aseptic technique when providing trache
    care to prevent infection
   e. provide adequate humidification
   f. Prevent complications from trache sunctioning
    – ( use careful suctioning technique to prevent
    tracheal trauma and possible infection .
   g. provide adequate hydration
ASSESS / MONITOR :
a.For signs of hemorrhage and shock
  following tracheostomy .
b.Vital signs
c.Assess for dyspnea / stridor / inspiratory
  effort / and signs of hypoxia
d.Assess for excessive mucous in airway
e.Assess for amount, thickness, quantity,
  color and odor of tracheal secretions
ASSESS / MONITOR :

 f. Assess respirations for rate, rhythm and depth.
 g. Stoma and skin surrounding stoma for signs
     of inflammation or infection
 h. Clients ability to cooperate with trache care
     and suctioning .
 i. Assess the client’s arterial blood gases and
     oxygen saturation values
 j. Assess the movement of air through the
     tracheostomy tube
ASSESS / MONITOR :
k. Assess for tracheoesophageal fistula
    before feeding orally .
j. Assess for constipation
k. Assess oral mucosa for dryness
l. Assess for anxiety, restlessness and
    fear
m. Assess the client’s understanding of the
    procedure
 AGE RELATED CHANGES –
  GERONTOLOGICAL CONSIDERATIONS
1.Many elderly persons experiences less
  effective coughing , which can lead to an
  accumulation of secretions . The reduced
  airway clearance may result in
  accumulation of carbon dioxide and
  reduced oxygen exchange . Efforts to
  clear the tracheostomy are particularly
  important to prevent impaired gas
  exchange .
GERONTOLOGICAL
CONSIDERATIONS

2. Maintaining good hydration in the elderly is
  important to reduce the viscosity of secretions .
  Many older persons have decreased thirst and
  may risk for dehydration . Thick mucous
  compromises airway patency and increases
  the risk for pneumonia and atelectasis .
  Nursing interventions to improve hydration
  status are an important part of the care of the
  elderly client with tracheostomy .
ATTENDING A PATIENT WITH TRACHEOSTOMY
Procedure:

 1. Identify client and introduce self.
    Explain procedure.
 2. Wash hands.
 3. Lower side rails near you.
 4. Remove soild dressing from the
    tracheostomy site with a clamp and
    discard into the receptacle.
Procedure:
 5. Open tracheostomy set.
 6. Pour hydrogen peroxide solution and sterile
    water in separate emesis basins.
 7. Open sterile package of cotton-tipped
    applicator aseptically.
 8. Wear clean gloves
 9. Dip cotton-tipped applicator in the emesis
    basin of hydrogen peroxide. Cleanse neck
    plate, then rinse with a cotton applicator
    dipped in the emesis basin of saline
Procedure:

 10. Then, repeat procedure unto the skin
     underneath the neck plate.
 11. Suctioning of secretions via
     tracheostomy tube before removing
     inner cannula may be done.
 12. Remove inner cannula by unlocking
     from outer cannula.
Procedure:

 13. Remove inner cannula gently (counter
     clockwise then pull upward)
 14. Immerse inner cannula in a basin of
     hydrogen peroxide.
 15. Dry skin, then the neck plate with a dry cotton
     applicator
 16. Use a sterile cotton applicator to clean the
     inner cannula with a hydrogen peroxide
Procedure:
 17. Place inner cannula in a basin of sterile
     water or saline.
 18. Remove contaminated gloves.
 19. Open to sterile packages of gauze pads
 20. Wear sterile gloves
 21. Rinse inner cannula with sterile water or
     saline. Dry inner cannula. Tap in
     sterile gauze pad to remove excess
     fluid. Return inner cannula clockwise
CLEANING THE INNER CANNULA
PLACING BACK THE INNER CANNULA
Procedure:

 22. Place the other sterile gauze pad around the
     cannula underneath the neck plate.
 23. Remove gloves and wash hands

 Changing Tracheostomy Ties:
 24. Measure the length of the tie around the
     neck and add 6cm to allow for tying of the
     knot.
Procedure:

 25. Insert end of the twill tape through the
     eye on one side of the neck plate. Pull
     the distal end of the tie through the cut
     and pull gently.
 26. Insert the other end of the twill tape
     through the eye on the other side of the
     neck plate. Pull end of the tie and knot
     securely.
Procedure:

 27. Cut old tracheostomy ties and discard.
 28. Insert one finger under the
     tracheostomy tapes to ensure fitting
     snugly.
 29. Discard all used materials and washed
     hands.
THERAPEUTIC NURSING INTERVENTIONS
   FOR ARTIFICIAL AIRWAY CARE
1. Check cuff pressure ( on some types of tubes )
2. Assure that O2 is being delivered correctly and
   that it is warmed and humidified
( to prevent drying of secretions )
3. Keep foreign objects ( apply protective dressing)
4. Suction to remove secretions .
5. Always have a suction set up and obturator /
   clamp at the bedside for emergency use .
6. Provide means of communications .
7. Keep call light / bell close at hand .
8. Provide frequent reassurance , explanations
  and anticipation of needs , to prevent anxiety .
9.Clean the inner cannula once or twice a day
10. Change the stoma dressing as often as
  needed
11. Deflate cuff tubes before oral feeding unless
  if the client is at high risk for aspiration
SUCTIONING
SUCTIONING
OROPHARYNGEAL , NASOPHARYNGEAL, ET
 TUBE , TRACHEOSTOMY

KEY POINTS :
> Suction is performed to clear airways ;
  frequency is determined by the client’s
  condition .
 Suctioning irritates the mucosa and removes
  oxygen from the respiratory tract .
 Suctioning should be painless and relieve
  respiratory distress .
 It is normal for suctioning to cause coughing ,
  sneezing , or gagging .
Key Procedural Points :
- Use sterile technique
- Determine proper length of tube to insert
- Hyperventilate or oxygenate client before
  suctioning
- Do not apply suction while inserting the
  tube
- Restrict suction time to 5 to 15 seconds
- Encourage the client to cough and deep
  breathe between suctions .
- Allow rest between suctions
- Protect self against exposure to body
  fluid
- Document the amount , consistency ,
  color , and odor of sputum ; and
  respiratory status .
SIGNS and SYMPTOMS of the NEED for
  SUCTIONING
1. Bubbling or rattling breath sounds .
2. Decrease breath sounds .
3. Dyspnea
4. Pallor and Cyanosis
5. Decreased O2 saturation level ( SaO2
  level )
6. Drooling , vomitus in mouth
POTENTIAL COMPLICATIONS
OF SUCTIONING

    Infection
    Cardiac arrythmias
    Hypoxia
    Mucosa trauma
    Death
MODES OF SUCTIONING
1. Oropharyngeal Suctioning – is done to
   evacuate vomitus from patients having an
   altered gag reflex
2. Nasopharyngeal Suctioning – is intended to
   remove accumulated saliva, pulmonary
   secretions, blood, vomitus and other foreign
   material from the trachea and nasopharyngeal
   area that could not be removed by patient’s
   spontaneous cough or other less invasive
   procedures
3. Endotracheal Suctioning –is a
  component of bronchial hygiene
  therapy and mechanical ventilation
  and involves the mechanical
  aspiration of pulmonary secretions
  from a patient with an artificial airway
  in place.

4. Tracheostomy Suctioning
PROCEDURE POINTS
Use aseptic technique
Hyperoxygenate the client by a
   resuscitation bag, increasing the oxygen flow
rate, or by asking the client to take  deep
breaths
Do not apply suction while inserting catheter
Apply suction intermittently for 10 seconds;
   rotate catheter while withdrawing
Hyperoxygenate client and encourage
  deep breaths
Instruct client to take several deep
  breaths and then cough deeply to obtain
  sputum
Lubricate the catheter with sterile water
MATERIALS FOR SUCTIONING :
SUCTION KIT
Suction catheter – size depends on the
 client ( adult / pedia catheter available )
Saline solution or distilled water
Sterile gloves ( clean and plastic gloves
 used due to unavailabity of sterile gloves )
 Paper towel
 Suction machine ( portable or built in )
 Oxygen ( tank portable or built in / identify the
  materials connected to the O2 apparatus ( e.g
  humidifier , etc )
 Ambu bag / pediatric set
 Oropharyngeal and nasopharyngeal airways
Procedure and policies varies / principle is
  observed
THERAPEUTIC NURSING INTERVENTIONS :
   OROPHARYNGEAL AND
   NASOPHARYNGEAL SUCTIONING
- To remove secretions from the upper respiratory
   tract when the client can cough effectively , but
   unable to expectorate or swallow them .
Assess the need for suctioning / provide
   privacy / promote client safety and comfort
1. Oral : semi fowlers with head turned to one side
   if conscious with a functional gag reflex .
2. Unconscious – side lying , facing the nurse
3. Place towel on pillow under the chin .
4. Proper suction pressure ( wall suction 110 – 150
   mmHg for adults )
5. Catheter ( tip of the nose to the earlobe )
6. Check patency
7. Oral ( moisten catheter tip with water ) / nasal
   – ( lubricate the catheter tip with water
   soluble lubricant )
8. Other part of the procedure follows
Prevent fatigue and hypoxia ( allow resting
   period of 20 to 30 sec )
Prevent infection / protect against contact to body
   fluids
Evaluate effectiveness of suctioning
SPUTUM OR SPECIMEN COLLECTOR
Assessment:

 1. Assess respirations for rate,
    rhythm, and depth
 2. Auscultate lung fields
 3. Monitor arterial blood gases and
    oxygen saturation values
 4. Assess for excessive secretions
Assessment:

 5. Monitor secretions for amount,
    color, consistency
 6. Assess anxiety and restlessness
 7. Assess for client’s
    understanding of the suctioning
    procedure.
Procedure:

 1. Identify client. Introduce self. Explain
    the procedure to the client.
 2. Assess respirations and breath sounds.
 3. Assemble materials needed. Open
    suction catheter and sterile bottle.
 4. Position the client in high Fowler’s or
    semi-Fowler’s position.
Procedure:

 5. Hyperoxygenate client before
    suctioning.
 6. Wash hands.
 7. Put on gown, mask, and goggles or
    face shield. Wear gloves.
 8. Designate one gloved hand as sterile
    and the other as clean
Procedure:

 9. Connect extension tubing to
    suction device using clean hand.
 10.Using sterile hand, pick up the
    suction catheter. Grasp plastic
    connector end between your thumb
    and forefinger and coil the tip
    around your remaining finger.
Procedure:
 11. Pick up the extension tubing with your
     clean hand. Connect the suction
     catheter to the extension tubing. Do not
     contaminate the catheter.
 12. Adjust suction control using clean hand
 13. Position clean hand with the thumb over
     the catheter’s suction port
 14. Rinse the catheter tip by dipping into
     the sterile solution and activate suction
Procedure:
 15. Observe the solution drawn into the
     catheter
 16. Remove thumb from the suction port
 17. Using clean hand, remove the oxygen
     delivery device and place it on a clean
     surface
 18. Without occluding the suction control
     port, insert the catheter tip gently (in
     accordance to type of suctioning)
Procedure:

 19. Apply suction intermittently by occluding
     the suction control port with your thumb
     while rotating the catheter and
     withdrawing it. Apply suction no longer
     than 10 seconds
 20. Repeat suctioning until all oral
     secretions have been cleared. Allow
     brief rest periods between episodes
Procedure:

 21. Rinse catheter with sterile water after
     each suctioning.
 22. Administer oxygen after suctioning
 23. Use separate catheter and sterile water
     for suctioning ET tubes, TT tubes and
     nasal / oral cavity. If using one
     catheter, suction ET or TT then nose
     and mouth respectively
Procedure:

 24.Disconnect the catheter from the
    extension tubing. Discard catheter
    and gloves in the appropriate
    container.
 25.Wash hands.
 26.Provide the client with oral hygiene
    if indicated or desired
ATTACHING SUCTION CATHETER TO SUCTION TUBINGS
NASOPHARYNGEAL SUCTIONING
TRACHEOSTOMY SUCTIONING
TRACHEOSTOMY MASK
ENDOTRACHEAL
INTUBATION
 The insertion of a tube into the trachea to
  allow air to enter the lungs.
INDICATIONS FOR ET
INTUBATION:
 a. Cardiopulmonary Arrest
 b. Patient in deep coma or
   unresponsive
 c. Shallow or slow respirations
   (less than 8 per minute)
 d. Progressive cyanosis
INDICATIONS FOR ET
INTUBATION:
 e. Surgical patients where body
    positioning or facial contours
    prevents the use of a mask
 f. To prevent loss of airway at a later
    time, i.e. a burn patient who inhales
    hot gases may be intubated initially
    to prevent his airway from swelling
    shut
CONTRAINDICATIONS
FOR ET INTUBATION:
  Obstruction of the upper airway
    due to foreign objects
  Cervical fractures
  The following conditions require
    caution before attempting to
    intubate:
    Esophageal disease
CONTRAINDICATIONS
FOR ET INTUBATION:

   Ingestion of corrosive substances
   Mandibular fractures
   Laryngeal edema
   Thermal or chemical burns
PROCEDURAL POINT FOR ALL
  SUCTIONING
1.Use sterile technique
2.Determine the proper length of tube to
  insert .
3.Hyperventilate or oxygenate the client
  before suctioning .
4.Do not apply suction while inserting the
  tube .
5.Apply suction while rotating and
  withdrawing the catheter .
PROCEDURAL POINTS FOR ALL
SUCTIONING

6. Restrict suction time to 5 to 15 seconds to
    minimize oxygen lost .
7. Encourage client to cough and deep breathe
    between suctions .
8. Hyperventilate or oxygenate between
    suctions .
9. Let client rest between suctions .
10. Evaluate respiratory status before and after
    suctioning .
11. Protect against exposure to body fluids .
CHEST TUBES
 CHEST TUBE ( WATER SEAL BOTTLE )
  – Chest tubes are usually inserted through
  an intercostal space into the pleural cavity
  .
Indications :
1.Following chest surgery
2.Trauma
3.Pneumothorax – collection of air or other
  gas in the pleural space that causes the
  lung to collapse .
4.Hemothorax – accumulation of blood and
  fluid in the pleural cavity , usually a result
  of trauma or surgery
KEY POINTS
Chest tubes are inserted in the
 emergency department , in the
 operating room via a thoracotomy
 incision , or the client’s bedside .

The chest tube may be positioned
 anteriorly through the second
 intercostal space to remove air .
The second tube maybe positioned
 posteriorly through the 8th and 9th
 intercostal space to remove fluid and
 blood .
The tubes are sutured to the chest
 wall , an airtight dressing is placed
 over the puncture wound .
The tubes are then attached to
 drainage tubing and drainage system
THERE ARE 4 TYPES OF DRAINAGE SYSTEM :
- One bottle system : water and collection of
  drainage in same bottle .
- Two bottle system : water seal and collection
  drainage in separate bottles
- Three bottle system : water seal , collection
  drainage and suction control in separate bottles .
- Disposable single units that work the same as
  the three bottle system ( pleur- evac, atrium ,
  thora – seal )
 Air and fluid move from an area of high
  pressure ( intra – pleural space ) during
  expiration to an area of low pressure ( drainage
  system ) .
 The usual water depth in a water seal system
  is 2 cm .
 Chest tube are removed when the lungs have
  re-expanded and / or there is no more fluid
  drainage .
 it usually takes 2 or 3 three postoperative
  days of chest drainage for the lung to fully
  expand .
Opening of incision with a
Kelly clamp
Kelly clamp guiding
insertion of the chest tube
Insertion of a trocar chest
tube
GOALS OF COLLABORATIVE MANAGEMENT :



1.Evacuating blood and fluid from the pleural
  cavity .
2.Preventing contamination of the pleural
  space .
3.Preventing accidental elevation or
  overturning of drainage bottles .
4.Re – expanding the collapse lung .
GOALS OF COLLABORATIVE MANAGEMENT :



 5. Re – establishing a satisfactory
    ventilation – perfusion ratio .
 6. Preventing accidental removal of chest
    tubes .
 7. Controlling client’s discomfort and
    anxiety .
 8. Maintaining oxygenation and tissue
    perfusion .
IMPORTANT NURSING DIAGNOSIS
( ACTUAL AND POTENTIAL )


 1.   Impaired gas exchange .
 2.   Ineffective breathing pattern .
 3.   Anxiety and fear .
 4.   Risk for injury .
 5.   Risk for infection .
 6.   Impaired mobility .
CLINICAL OVERVIEW : Chest tubes are inserted into the intrapleural space to remove air and
   fluid to reestablish negative intrapleural pressure . This allows the lungs to reexpand .
   Chest drainage which is collected in the drainage system , will be measured and sent to the
   laboratory for analysis .
RISK FACTORS NECESSITATING CHEST TUBES



 1. Blunt , crushing or penetrating
    chest injuries .
 2. Tension pneumothorax – ( fluid
    shifting from unaffected area )
 3. Hemothorax – ( air )
 4. Hemopneumothorax – ( blood and
    air )
 5. Thoracic surgery
 6. Invasive thoracic procedure
SIGNS AND SYMPTOMS NECESSITATING CHEST
TUBES:


 1. Air hunger
 2. Agitation
 3. Hypotention
 4. Tachycardia -
 5. Severe diaphoresis
 6. Absence or diminished breath sounds on the
    affected area
 7. Tension pneumothorax
 8. Cyanosis
DIAGNOSTIC LABORATORY TEST
1. History and physical examination
2. Pleural fluid analysis
3. ABG analysis
4. Chest x-ray following removal of the
   chest tube
THERAPEUTIC NURSING MANAGEMENT



1. ASSESS / MONITOR

 For blockage of drainage – note for oscillation

 For air leaks
  - continuous bubbling in the water seal
  chamber during inspiration and expiration rather
  than intermittent bubbling signifies that there is
  an air leak in the system
THERAPEUTIC NURSING MANAGEMENT

 To determine the source of the air leak ,
  - check for loose catheter and also thoroughly
  the tubing and all the connections

 To stop the air leak
  - place sterile petroleum gauze around the
  insertion of a loose chest tube , or re-tape the
  loose tubing connections . If these measures
  do not work , it may be necessary to change
  the entire system .
THERAPEUTIC NURSING MANAGEMENT


 Vital signs / Breathe Sounds /Chest Wall
  for Unusual Chest Movements
 O2 saturations
 Chest tube insertion site for redness ,
  pain , infection , crepitus
 Wound for excessive drainage or signs of
  infection following chest tube removal
 Client for signs of recurrent
  pneumothorax
n




NURSING ACTIVITIES :
1. Assist physician with the insertion of chest
  tube and set up of drainage system /
  emergency procedure is performed at the
  bedside .
2. Keep all tubing straight and coil loosely .
3. Prevent client from lying on tubing .
4. Make certain that connections between
  the chest tubes , drainage tubing , and
  drainage collection bottles are tight .
NURSING ACTIVITIES :

 5. Tape connections securely to
   prevent air leaks .
 6. Tape tops of bottles .
 7. Re – tape all connections if
   necessary .
 8. Milk and strip the chest tubes if
   necessary to increase amount of
   negative pressure to the pleural
   space .
NURSING ACTIVITIES :


 9. Take precautions that drainage bottles
   are never elevated to the level of the
   clients chest .
 10. Do not empty drainage bottles unless
   overflowing .
 11. Never clamp chest tubes without a
   doctors order unless during emergency .
 12. Encourage client to cough and deep
   breath , sit up in bed and ambulate .
NURSING ACTIVITIES :


 13. Provide pain medication one half hour before
   removing chest tube .
 14. After removal of chest tube apply airtight
   sterile petroleum jelly gauze dressing .
 15. Order chest x-ray as needed following
   removal of the chest tube .
PHARMACOLOGY
1. Antiseptic solution to prepare site for
  chest tube .
2. Local anesthetic ( lidocaine )
3. Sterile petroleum jelly gauze
  following chest tube removal .
4. Pain medication ( morphine and
  meperidine )
5. Antibiotics ( if bacterial infection is
  present )
COMPLICATIONS :
1. Infection
2. Recurrent or new pneumothorax
3. Respiratory failure
AGE RELATED CHANGES –
GERONTOLOGICAL
CONSIDERATIONS
 > Changes   in fat deposition difficult
   to identify landmarks of insertion
 > Proper positioning for
   thoracotomy maybe difficult for
   the older person with impaired
   mobility or range of motion .
 THANK YOU AND GOD BLESS!!!!!!

								
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