Chest Tube (PowerPoint) by wuyunqing

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									prepared by :
Sana’a AL-Sulami
Teacher Assistant
Nursing Department
 Definition
 Chest tube indication
 Purpose of chest insertion
 Sites for tube insertion
 types of drainage system
 Prepare the patient for chest tube insertion
 Performance chest tube procedure
 Risks and complications
Learning objectives:
At the end of this procedure , the students must be able to :
 Define the chest tube.
 List of Chest tube indication
 List of the Purpose of chest insertion
 Describe the Sites for tube insertion
 Discuss the types of drainage system
 Describe how to Prepare the patient for chest tube
 Performance chest tube procedure
 List of the Risks and complications
 A chest tube insertion is a procedure to place
 a flexible, hollow drainage tube into the
 chest in order to remove an abnormal
 collection of air ,blood or fluid from the
 pleural space (located between the inner and
 outer lining of the lung).

 Traditional chest drainage unit consists of a
  collection chamber, water seal chamber, and
  suction control chamber.
 Depending on circumstances, the practitioner may
  insert a chest tube at the bed side or send the
  patient to the operating room.
 Pneumothorax.
 Hemothorax.
 Pleural effusion.
 Chylothorax.
 Empyema.
 Hemopnemothorax.
 To return negative pressure to the intra
  pleural space.
 To drain air from intra pleural space.
 To drain blood and fluid from intra
  pleural space.
 Chest tube can administer therapy.
 Relieve respiratory distress.
 In the lung apex at the second or third inter-costal
  space, mid-clavicular line to drain air.
 In the lateral chest area at the lower site, usually
  the eighth or ninth inter-costal space to drain
  blood or fluid.
 Inthe anterior media-stinal beneath the sternum,
  which called retro-sternal tube in case of cardiac
Types of drainage system:
 Thoracentesis is insertion of the needle into the
  pleural space to drain air or fluid.
 The single bottle system is used to drain air or
  small amounts of fluid from the pleural space.
 Two chamber system work as a single-bottle
  chest drainage system, but it decrease the
  workload of breath.
Types of drainage system:
 Three chamber system set up uses a drainage-
 collection chamber connected to a water-seal chamber
 that is attached to a vacuum-control chamber.
  Prepare the patient for chest tube
 Make sure your patient has given informed
 Reinforce the practitioner’s explanation of the
  procedure with him and his family.
 Explain that his breathing will be easier once the
  tube is inserted and his lung starts to re-expand.
 Tell him he will receive a local anesthetic to reduce
      Performance chest tube
 Assessment:
  Obtain  vital signs
  Observe any changes in heart rate,
   blood pressure, respiratory pattern,
   increased apprehension, and chest
  Assess patient for knowing allergies.

  Review patient’s medication record
   for anticoagulant.
           Performance chest tube
 Planning:                        Dressing
                                   Two clamps
    Wash hands.
                                   Obtain the appropriate
    Prepare the equipment:         CDU
      Injectable lidocaine        Knife handle
      An antiseptic               Knife blade
      Sterile gloves              3.0 silk suture
      Sutures                     3 hand towels
      Sterile water               Head cover
      Suction control chambers    Mask
      Suture scissors             Needle holder
      4*4 inch sterile gauze      20 ml syringe
      Petroleum gauze
      Adhesive tapeH
 Explain procedure to the patient.
 Set up the CDU to the manufacturer’s structure.
 Fill the suction control chamber with sterile water to
  the 20 cm H2O level, or as prescribed.
 To start suction, connect the tubing on the suction
  control chamber to a suction source and turn up the
  pressure until you see gentle, steady bubbling in the
 Monitor the CDU water levels and add sterile water as
 Help position the patient for the procedure.
 The practitioner cleans the patient’s skin with
  iodine or other antiseptic solution and drapes
  the area.
 The practitioners anesthetizes the skin.
 Through a small skin incision, the practitioner
  penetrate the pleural space with a hemostat
  and creates a tract that she can use to insert
  the catheter.
 Connects   its distal end to the CDU.
 Uses suture to fix the tube at the insertion
 Applies 4*4 inch piece of sterile gauze with a
  slit over the tube and places an occlusive
  dressing over the gauze on the chest wall.
 Chest x-ray must be done.
 Assess his breath sounds bilaterally.
 Encourage the patient to cough and
coach him in deep breathing.
 Keeps  all tubes free from kinks.
 Keep the collection apparatus below the
  patient’s chest level
 Add water to maintain the manufacturer's
  recommended level.
 The water seal level should fluctuate with
  respiratory effort.
 Assess the color of drainage in the drainage
  tubing as well as the collection chamber.
 Measure the drainage level every 8 hours.
Recording and Reporting:
 Document the amount of drainage and its
  characteristics in your patient’s medical record.
 Immediately report more than 70 ml/hour of bright
  red blood or red free – flowing drainage.
 Record baseline vital signs.(record vital signs every 15
  min. for at least 2 hours after procedure).
 Record and report stated allergies or anticoagulant
  medications the patient is taking.
 Ensure the tubing is not kinked.
 Gently milk the tubing in the direction of the
    drainage system.
   Maintain drainage system below the level of the
   Turn the client frequently.
   Report drainage on the dressing immediately .
   Observe for fluctuation of the fluid in tube .
   Palpate the area around the chest tube insertion
 situate the drainage system to avoid breakage.
 Place tow clamps at the bedside .
 Encourage the client to coughing and deep
  breathing every 2 hours.
 Instruct the client to exhale or strain as the tube
  withdrawn by the physician.
 Encourage movement of the arm on the affected
 Evaluation the client.
  Practitioner will remove patient’s chest tube
                  according to:
 The drainage has decreased to little amount or none.
 The patient is breathing normally without respiratory
 Breath sounds are at baseline.
 Fluctuations in the water seal have stopped.
 Chest x-ray shows lung re-expansion with no residual
  air or fluid in the pleural space.
 Place the patient in semi-fowler’s
  position or on his unaffected side.
 Place a linen saver pad under the
  affected side .
 Put on clean gloves and remove the
  chest tube dressings. discard the soiled
 The physician puts on sterile gloves
  holds the chest tube in place with sterile
  forceps , and cuts suture anchoring the
 Make sure the chest tube is securely clamped,
  and instruct the patient to perform Valsalv’s
 The physician holds airtight dressing, usually
  petroleum gauze , he can cover the insertion site
  immediately after removing the tube.
 Dispose the chest tube, soiled gloves, and
  equipment according to your facility’s policy.
 Take the vital signs as ordered and assess the
  depth and quality of the patient’s respiration.
Risks and Complications:
 Bleeding.
 Infection.
 Subcutaneous emphysema.
 Other rare potential include lung trauma, broncho-
 pleural fistula.

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