1. JASON MORGAN MS, RN

2. Pleural Effusion What is the underlying cause of the effusion? Malignancy? Liver failure? – Hepatic hydrothorax Post-op complication? – Common following cardiothoracic surgery Hepatic Hydrothorax – Pressure changes in the thoracic cavity with inspiration with acities fluid can cause a fluid shift into the pleural space. Treatment options Thoracentesis – “tap their lung” Pleurodesis – Obliterates the pleural space; used for people for recurrent effusion We will see a chest tube or pigtail drain placed – The smaller tubes can be left in for chronic patients – Patients can be discharged with a pigtail they can flush and care for at home. – There can also be a shunt placed that drains into the peritoneum

3. Chest tube set-up Suction – Not all chest tube set-ups with be to suction – Some are to water seal In draining an effusion you can use gravity or suction… is gravity effective enough? Clamping chest tubes – You clamp a chest tube set up that is for a pleural effusion to stop output YOU NEVER CLAMP a chest tube that is being used to treat a pneumothorax Why? – Clamp  changes in thoracic pressure  tension pnuemothorax  lung collapses  trachea deviates  inferior vena cava compressed  no return flow to heart  cardiac arrest

4. This will bubble if there is an air leak Don’t adjust JM 1/11 1230 Connect to suction tubing Never clamp when used to treat pneumothorax Draw a line Date/time/initials tracks output

6. Pigtail catheter

7. PneumothoraxHemothorax Can you see the collapsed boarder?

8. Air leak Check the patient  Are they tachypnic/distress/RR/ 02 sat?  Ask them take a deep breath, check for bubbles in chamber Check the tubing  Are all the connections secure?  Is there damage to the tubing? Check the dressing  Is the dressing occlusive?  Does it need reinforcement/Vaseline gauze Call the team

9. Tube pulled A catheter in placed into the pleural space to drain a collection of fluid. You may gently flush the catheter, according to orders, and let drain to gravity. If the tube is pulled out, it is in the pleural space, there should not be air escaping. Call them team. If this is a chest tube for a pneumothorax place Vaseline gauze over the site with a dressing taped on 3 sides. Air can go out but not in… air in the chest cavity changes pressure and can lead to tension pneumothorax