2 Objectives:Discuss the anatomy of the chest and the mechanism of respirationsDiscuss the indications for a chest tubeDiscuss the structure and function of the chest bottle (drainage system)Troubleshoot the problems with/maintain chest tubes and chest tube bottles
4 Pleura:Lungs are surrounded by two thin layers (films) called the pleurae They function as lubricant, preventing the lungs from rubbing with the rib cage during inspiration and expirationVisceral:Outside the lungsParietal:Inside the ribcageThe area between the two pleurae is filled with a fluid called the pleural fluid (that fills a pleural space)The pleural fluid acts as a lubricant so the two films don’t rub each other
5 THE PLEURAL SPACE HAS ALWAYS A NEGATIVE PRESSURE. OTHERWISE, THE LUNGS WILL COLLAPSE
6 Pleural Pressure:The degree of negativity changes throughout the respiratory cycleIntrapleural pressure normally ranges from –(4) to –(10) cm of waterInspiration pressure drops to –(10) cm waterExpiration pressure rises up to –(4) cm waterIt is the pressure variance that allows the air to move in and out easily
7 Definition of the chest drainage Is the insertion of a tube into the pleural and/or mediastenal space and a physician order required for the type of evacuation force: a-normally 20cm for adultb-10-15cm for pediatricThe drainage must be kept always lower than the patient to prevent backflow of fluid into the pleural or mediastinal space.
8 Indications of a Chest Tube: PneumothoraxHemothoraxHemopneumothoraxPleural EffusionEmpyemaDrainage
9 Chest tube locationFor evacuation of air: 2,3,4 intercostals space are commonly used sites.To drain fluid : 5,6 intercostals space are commonly used sites.
11 Fluid Collection Chamber: Collects fluid as it drains from the pleural space or mediastinal spaceWater Seal Chamber:Acts as a one way valve, allowing air to escape from the patient and never return back. Always 2 cm of water.Suction Control Chamber:Controls the amount of suction applied directly to the patient. It improves the rate and flow of drainage.
13 Subcutaneous Emphysema: When the lungs or the air passages are injured, air may enter the tissue planes and pass for some distance under the skin.The tissues give a crackling sensation when palpated, and the subcutaneous air produces an alarming appearance as body becomes misshapen.It is not a serious complication if the air is spontaneously absorbed or stopped, or if the leak is treated.
15 Site:Check for:Clean and dry dressing: change every 72 hrs ,use a prim pore dressing and clean with sterile technique.Subcutaneous emphysema1. palpate contious monitoring2.notify doctor
16 Tubing: Connections are secured No dependent loops Straighten periodicallyKeep bottle below patient’s levelTape the connections if 2 suction tubes are used
17 Output: Amount, type and color Mark regularly Document Use the white on columnon the drainage chamber tomark drainage level
18 Patency: A-water seal chamber Assess the Water seal with the suction offIf water seal level is too high, it will be more difficult for air leave the chestIf the water is too low ,it leaves the water seal chamber at risk for exposure to air can cause a pneumothorax
19 Patency: B-Bubbling:Bubbling means there is a leak in the system unless the patient has a pneumothorax.
20 How to Check for an Air Leak? Clamp the tube below the dressing Bubbling continues?No Leak is between patient and dressingYesContinue clamping
21 Patency: C-fluctuation When inspiration the water seal level will reach -10cm of negative pressure normallyWhen expiration the water seal level will reach -4cm of negative pressure normallyWhen fluctuation stopped so the tubing may be obstructedIf more than 2cm the drainage will decreasedIf less than 2cm there risk of pneumothorax
22 Patency :D-suction drainage units Assess the suction control water level when the suction is offExcessive bubbling in the suction control chamber result in evaporation of the water which will decreased in applied suction and does not increase the pressure on the pleural or mediastinal cavityNormally 80 mmhg of wall suction is required to ensure consistent delivery of suction
23 Patient Activity A semi-fowler position is required Position and turn the patient every 2 hrs3Patent can be out of bed if there is no contraindicationDo (ROM) exercises to the affected arm and shoulder siteEncourage coughing and deep breathing
24 Clamping: Clamp only when: Don’t clamp when: Changing the bottle Checking for an air leakTubing is disconnected and sterile water is out of reachIf changing the position and when elevating the tube system above the patient level is requiredDon’t clamp when::Ambulating a patient
25 Milking: Milking the tube is not recommended. It creates a pressure of –(400) to – (100) cm of water that can cause a tension pneumothorax