Presentation on theme: "Chest Tubes and Drainage Systems"— Presentation transcript:
1Chest Tubes and Drainage Systems Deb Updegraff RN, CNSPICULPCH
2Chest Tubes Correct life threatening conditions caused by excess of fluid and/or air in the intrapleural space
3Tension-Pneumothorax A collection of air in the pleural space.Can occur withCentral line placementChest surgery,Trauma to the chest wallTraumatic intubationMechanical ventilationTension-PneumothoraxIf air continues to collect in the chest, the pressure can rise and pushthe whole mediastinum over to the other side
4“Intra” pleural Space There are 2 pleural membranes involved in respirationvisceral pleuraparietal pleuraThe Parietal pleura lines the inside of the thoracic cavity. The visceralPleura adheres to the outside of the lung.
10Pleural Effusion The accumulation of pathologic quantities of fluid in the intrapleural space.Maybe caused by:Liver and kidney failureCongestive heart failureInfectionMalignancy blocking the lymphatic system
14EmpyemaInflammatory fluid and debris within the intrapleural space. Usually results from an untreated bacterial pneumonia.Other causes:Thoracic traumaRupture of lung abscess into the pleural spaceExtension of mediastinal or abdominal infectionIatrogenic at time of thoracic surgery
15Insertion Sites for Chest tubes Patient PositioningInsertion Sites for Chest tubesPneumothorax: (AIR)The best position is supine or withhead elevated anywhere from low to high fowler’s.The chest tube will be inserted into the 2nd or 3rd intercostal spaceanterior chest at the mid-clavicular lineEffusions: (FLUID)If patient able, best position is sitting on the side of the bed leaningover a pillow placed on a bedside table.The chest tube is inserted between the 4th to 6th intercostal spacemid-axillary line
20First 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.
21Second ChamberSingle chambers are fine if all you want to drain in air.When there is fluid it’s time for a second chamber.21
22Third ChamberHere’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.2131 water seal chamber2 drainage chamber3 suction chamber
23Water seal chamberDrainage chamberSuction Chamber312
24Third 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 thewater acts as the suction limiter. No matter howHard the wall suctions pulls, the actual suction delivered tothe patient is 15cm.
25Now back to Air Leaks First Chamber-Water seal chamber This chamber shows an air leak. This is aGood thing if you have just placed the tubeFor a pneumothorax. It means the air isGetting out of the patient.This does not automatically mean that air isComing out of the chest.The leak can be coming from anywhere in theSystem and this can be bad.11
26If 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 hearthis with a stethoscope.What to do:Take dressing down wrap hole with Vaseline gauzeCall for a stat CXR.
27Clamping a Chest tube Clamping a chest tube is a very big deal Only clamp if you are:Changing a full pleurovacOr if you areTrying to determine if the system is leaking.
28It means to disconnect from wall suction Water SealUsually 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-accumulationIt means to disconnect from wall suction