Indications (PowerPoint)

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					        CHEST TUBES
Kelsey Bolt, Natasha Chelli, Katy Gaebler, Katelyn Herder,
      Mariam Opoku, Ian Saunders, Carli Simpson,
               Question


 What do the following patients have in
 common?
Mary
Jack
Sandy
Chris
      Anatomy & Physiology
 Lower respiratory tract.
 Layers of the pleura
                     Indications
 When Air (pneumothorax), blood (hemothorax), pus
  (pyothorax), or lymph (chylothorax) collect in the pleural
  cavity

 Cardiac or thoracic surgery
 Chest trauma
 Administer therapy
                            3 Bottle System
                 Tube open to
                 atmosphere
                 vents air
Tube to                                                                  Tube from patient
vacuum
source




Straw under 20                                                            Fluid
cmH2O                                                                     drainage

                                   2cm fluid water
                 Suction control   seal              Collection bottle
                       Pleur-Evac
 Closed system
 Comes with 30ml syringe of sterile water
 Suction dial
 Suction indicator
 Air leak meter
 Collection chamber
 Positive pressure relief valve
 Filtered high negativity relief valve
       Preparation and Insertion
 4th or 5th intercostal space

 Chest tube sizes
  – #26-40 Fr. for blood or viscous fluid
  – #18-22 Fr. for air ONLY

 Pre and Post X-Ray

 Baseline vitals including O2 saturation levels
  Gravity Drainage            Suction Drainage

 Attach tube to collection   •   Attach to wall suction
  container                        –80-120 mmHg
 Add 30ml sterile water           (usually set at
  through injection port           100mmHg)
                                   –Watch for orange
 YES or NO will appear on         float
  indicator
        Heimlich One Way Valve

 Allows for drainage and prevents re-entry of air into
  pleural space

 Ideal for chronic pneumothroax or pleural effusion
 Increased mobility for patients
 Attached to a urinary collection bag
           Pediatric Considerations
 Chest tube sizes
    #16, 20 and 24 French

 Small infants may require
    #8-12 French

 3rd intercostals space at midaxillary line or 4th-5th intercostals
   space
              Complications
 Dislodging - Small tubes vs. larger tubes.
 Injury to internal organs - Know the point of
  Insertion
 Pain - The pleura is very sensitive
 Bleeding - Trauma to the intercostal arteries
 Occlusion
 Serious Harm and Death - Very low mortality rate.
  Death can occur
       Cause of Complications
 Anatomical abnormality
 To deep dilation
 Failure to consider patients position
 Failure to follow facility policy or procedure
 Lack of knowledge
 Poor imaging quality
 Poor technique
 Physical environment where inserted
       Nursing Management
 Assess and monitor:
   Tube patency
   Dressing
   Respiratory status
   Cardiovascular status
     ECG
    Nursing Management cont’d
 Chest tube system
 Patient positioning
 Physician orders
   chest x-ray, oxygen therapy
              Documentation
 Date & Time, vitals, O2 sats, pre and post treatment
 Tolerance to procedure
 Characteristics and amounts of drainage
 Amount of negative suction applied or if gravity
  drainage

 Chest assessment
      Documentation (cont’d)
 Type of dressing applied
 On pleur-Evac and clinical fluid balance record
 Amount of drainage q shift
    References


   Charnock, Y., & Evans, D. (2001). Nursing management of chest drains: a systemic review. Australian
    Critical Care, 14(4), 156-160. Retrieved from www.cinahl.com/cgi-
    bin/refsvc?jid=555&accno=2002041166

   Durai, R., Hoque, H., & Davies, T. W. (2010). Managing a chest tube and drainage system. AORN
    Journal, 91(2), 275-283. Retrieved from www.cinahl.com/cgi-bin/refsvc?jid=121&accno=2010555154

   Roman, M., & Mercado, D. (2006). Review of chest tube use. MEDSURG Nursing, 15(1), 41-43.
    Retrieved from
    http://web.ebscohost.com.roxy.nipissingu.ca/ehost/pdfviewer/pdfviewer?vid=11&hid=10&sid=37fd6de3-
    08b7-424a-9e29-0eba0fffae04%40sessionmgr14

   Coughlin, A.M & Parchinsky, C. (2006). Go with the flow of chest tube therapy. Nursing, 36(3), 36-42.

   Roman, M., & Mercado, D. (2006). Review of chest tube use. Medsurg Nursing, 15(1), 41-43.

   Allibone, L. (2003). Nursing management of chest drains. Nursing Standard, 17(22), 45- 56.

   National Institute of Health (2010). Chest tube insertion: Reasons and management.
    http://www.nlm.nih.gov/medlineplus/ency/article/002947.htm

   Journal of Surgical Nurses: Nursing implications. http://surgnurseslinks.com/chest.chesttubes.htm

   Nursing Considerations and Troubleshooting:
    http://www.teleflexmedical.com/ucd/nursing_considerations_troubleshooting.php
    http://www.health.vic.gov.au/__data/assets/pdf_file/0004/372109/chest_tube_management.pdf

				
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