1. Chest Tubes….Just Another Drain
(Yeah right)

2. Caring for a Patient with a Chest Tube
Let’s review some A & P
The lungs are wrapped by a double sided envelope of tissue called the _________.
The inner most layer is called the _____ _______.
The outer most layer is called the ______
_______.

3. On inspiration, the lungs move downward.
How We Breathe….
On inspiration, the lungs move downward.

4. The visceral and parietal pleura are separated by a thin film of ________.
On inspiration, the chest wall expands and the diaphragm moves _________.
During inspiration, the pressure within the thoracic cavity is < or > atmosp. pressure so air can rush in the lungs

5. During expiration, the intrathoracic pressure is > or < allowing air to exit the lungs.
If air or blood is introduced into the pleural space, the normal pressures are disrupted and the lung or lungs will collapse.
To drain this air and/or fluid off the pleural space, a chest tube is NEEDED.

6. Indications for Chest Tube Insertion
Pneumothorax: Presence of air in the pleural space
Hemothorax: Presence of blood in the pleural space
Hemopneumothorax: Presence of air and blood in the pleural space

7. Chest Tube Insertion
Pneumothorax: Chest tube will be placed at 2nd intercostal space since air ______.
Hemothorax: Chest tube will be placed in the 5th/6th or 8th/9th intercostal space since blood and fluid _________.

9. Types of Drainage Systems
Glass Bottle System:
1 bottle
2 bottle
3 bottle
Plastic System:
Thoraseal
Pleuravac

11. Principles of Chest Tube Functioning
The idea is to create a one way mechanism that will let air out of the pleural space and prevent outside air from coming in….why would this be a problem?
This is accomplished by the use of an underwater seal. The distal end of the drainage tube is submerged in 2cm of H2O.

12. Question????
How would the waterseal help in restoring negative intrathoracic pressure??

13. To Clamp or Not to Clamp????
What would happen if the chest tube exiting the patient’s chest became kinked or clamped????
Would it make a difference if it was a pneumo vs a hemothorax?

15. Tension Pneumothorax…Paging Dr. Carter
Trachea is deviated
Decreased or absent breath sounds on affected side
Blood pressure drops
Tachycardia
Dyspnea, Hypoxia, Hypoxemia
Decreased Cardiac Output

16. Care of the Patient with a Chest Tube

18. Atrium Chest Drainage System

19. Now Let’s Meet The Patient…..

23. Open Pneumothorax
Air enters the pleural space through an actual opening in the chest wall. Can you name some examples of how an open pneumo can occur?

24. Closed Pneumothorax
Air enters the pleural space without any external wound…..originates from within. Can you name some examples which would cause a closed pneumo?

25. Nursing Responsibilities/Care of Patient with Chest Tube
Keep drainage system 2-3 feet below patient’s chest
Keep tubing patent; make sure no kinks or clots present
Observe and record amount of drainage. >100cc/hr is heavy…notify physician.
Encourage TCDB, ambulation as ordered.

26. When a patient has a chest tube to gravity drainage, the nurse should:
A. Position the patient on his back
B. Restrict the patient of bedrest
C. Provide long tubing to reach the suction source
D. Keep the drainage chamber below chest level

27. The nurse knows to clamp the chest tube if:
A. The drainage unit is disrupted or broken.
B. The patient develops a tension pneumothorax.
C. Locating a source of an air leak.
D. The patient must be transported.

28. Any Questions???

29. The End…….