2 Caring for a Patient with a Chest Tube Let’s review some A & PThe 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 spaceHemothorax: Presence of blood in the pleural spaceHemopneumothorax: Presence of air and blood in the pleural space
7 Chest Tube InsertionPneumothorax: 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 _________.
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?
23 Open PneumothoraxAir 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 PneumothoraxAir 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 chestKeep tubing patent; make sure no kinks or clots presentObserve 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 backB. Restrict the patient of bedrestC. Provide long tubing to reach the suction sourceD. 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.