Presentation on theme: "By Diana Blum MSN Metro Community College NURS 2520"— Presentation transcript:
1 By Diana Blum MSN Metro Community College NURS 2520 Chest TubesBy Diana Blum MSNMetro Community CollegeNURS 2520
2 OBJECTIVESDEMONSTRATE THE ROLE OF THE RN IN NURSING INTERVENTIONS OF CHEST TUBESPERFORM THERAPEUTIC NURSING INTEVENTIONS TO CLIENTS WITH CHEST TUBES
3 Where exactly is a chest tube placed? The entry point is the fourth or fifth intercostal space, on the mid-axillary line. The tube is inserted towards the collection: sometimes up and in front, or up and in back, or wherever the collection lies.
4 EDUCATE ON WHAT A CHEST TUBE IS TO THE CLIENT ASSURE A CONSENT FOR PLACEMENT WAS OBTAINEDOBTAIN VITAL SIGNS PRIOR TO PROCEDURESET UP ROOM WITH CORRECT EQUIPMENTWET VS DRY SYSTEM
5 The area where the tube will be inserted is numbed Chest tubes are inserted to drain blood, fluid, or air and allow full expansion of the lungs.placed in the pleural space.The area where the tube will be inserted is numbedPLACE THE CLIENT IN SEMI FOWLER’S TO HIGH FOWLER’SThe chest tube is inserted between the ribs into the chest and is connected to a bottle or canister that contains sterile water.Suction is attached to the system to encourage drainage.A stitch (suture) and adhesive tape is used to keep the tube in place.A chest xray will be done daily to confirm placement. Dressing should be done daily or more to monitor site and check for air leak, CREPITUS, ETC.Dressing should have a tight seal. Monitor saturations, and look in the tube for blood clots.Drainage is Described as sanguinous, serosanguinous or serous
6 Pleural Chest Tubes Indications for pleural tube placement: HemothoraxPneumothoraxPleural effusionEmpyema (drainage of pus)Postoperative thoracostomyAllows air to exit the chest and prevents air from entering the chestUsually inserted at bedsideThere are two types of pleural tube connectionsUnderwater seal drainageOne-way valveThre are 2 types of Chest tubes: pleural and mediastinal. All are technically pleural however.
7 Mediastinal Chest Tubes Indications for a mediastinal tube include drainage of the mediastinal space after a surgical procedure, cardiac surgery, and creating a pericardial windowNo tidaling will be observed with mediastinal tubes due to their location in the mediastinal space as opposed to the pleural spaceRN must ensure patency and unobstructed drainageInserted in the operating room during surgery
8 Pre-Insertion Care Gather the necessary equipment Instruct client on procedure and expected outcomesCheck for allergiesAdminister analgesia and sedation per orderPosition client for insertion (semi-Fowlers to high Fowlers depending on reason for insertion)Assist physician with sterile field & apply mask to selfAssist physician with insertion of chest tubePlace Vaseline gauze dressing around tube at insertion site to prevent air from escapingFinish with occlusive 4x4 gauze dressing
10 Chest Tube Drainage Chest tube drainage systems act as a one-way valve Removes pleural drainageIncreases intrathoracic pressureDecreases chest wall pressureRestores negative pressure in the lungsTypes of chest tube drainage systems:Water sealDry suctionWater seal drainage system --Suction is determined by the amount of water in the water seal system and the amount of suction on the wallGentle bubbling sound is expected
12 Chest Tube Drainage (cont’d) Dry suction drainage system --Closed, one-way drainage systemOrange accordion-like object visible when suction appliedWall suction controls the rate of air flowThoracic pressure is determined by the pressure of the wall suction and the level of the water in the drainage system
15 Chest X-Ray Showing a Tension Pneumothorax The chest tube usually remains in place until the X-rays show that all the blood, fluid, or air has drained from the chest and the lung has fully re-expanded.Chest X-Ray Showing a Tension PneumothoraxSee the shifted mediastinum? – the trachea’s shoved over to the right.
16 Chest Tube Suction Chest tubes are often connected to suction Increases drainageAssists lungs in achieving re-expansionChest tube suction is typically set at 20cm (water pressure)Disconnecting the chest tube from suction does not allow air to enter the chest, but does stop the suctionIndications for removal of chest tube include:Diminished chest drainageFrequent re-expansion of the lungSuction is usually discontinued for a few hours prior to chest tube removal
18 When the chest tube is no longer needed, it can be easily removed, usually without the need for medications to sedate or numb the patient. Medications may be used to prevent or treat infection (antibiotics).
19 Post-Insertion CareAssess the client immediately after insertion and every 4 hours thereafterAssess vital signsCheck drainage appearance and amountShould be no greater than 100 mL/hRecord at least every 8 hoursCheck chest wall at insertion site for subcutaneous emphysemaObserve for tidalingCheck for kinks in the tubing if none notedIf air bubbles in the air leak indicator are observed, check entire tubing for air leaks
20 Post-Insertion Care (cont’d) Ensure suction is set at the ordered levelMake sure drainage system is positioned correctlyUpright and securedBelow the level of the client’s heartEnsure Vaseline gauze is available at bedsideMake sure client has had a post-insertion x-rayChange the drainage system receptacle as indicatedOnly when chambers are fullUse sterile technique
21 Tidaling: the middle water seal chamber is observed for expected rise in fluid level with expiration.Air leak: noted when continuous bubbling is observed in the main water seal chamberSuction may be wet or dryA gentle bubbling sound is normal to hear with a wet systemDry systems have a orange accordion looking object visible when suction is appliedChange the recepticle only when chambers are full using sterile techniqueHeimlich Flutter Valve: air and fluid are expelled and not rebreathed in
22 What is Empyema?This is a collection of pus in the pleural space, or in a big abscess space in the lung tissue itself.Pus can collect in large enough quantities to compress the lung, and certainly will act as a septic “focus” until it’s drained. Empyema can result from chest trauma - say, a gunshot or knife wound - or necrotizing pneumonia, or any other process that puts bacteria into the chest.
25 Chest Tube Complications Chest tube dislodgement --At the chest:Quickly apply Vaseline gauze (depending on type) to the chest insertion siteAssess for respiratory distressAt the drainage system unit:Clamp the chest tube while another nurse obtains a new drainage unitSet up new drainage unit and connect to chest tubeAttempt to complete this entire procedure in less than 1 minute to prevent complicationsClamping a chest tube can result in high risk for developing tension pneumothoraxRisk is increased with positive pressure ventilation
26 Chest Tube Complications (cont’d) Assess for chest tube dislodgement at the chest via placing stethoscope over dressing at insertion site and auscultating for whistling soundOccurs when the chest tube port has dislodged from the chest and is continuously sucking in air from the surrounding atmosphereStat x-ray indicated as air may be dangerously re-accumulating in the chest
27 What if it tips over?You place the container back in the upright position. Mark the chambers where the blood is or replace chamber if needed.Check the pt