When to Use or Not Use By Don Hudson D.O. December 17 CHEST TUBES When to Use or Not Use By Don Hudson D.O. Breathing Management

Chest Tubes Indications and purpose December 17 Chest Tubes Indications and purpose drainage of fluid and air from pleural space or mediastinum used to treat pneumothorax, hemothorax, hemopneumothorax and empyema (pus) useful in fluid collection helpful in respiratory assistance Breathing Management

Positioning Breathing Management

. Complications Chest Tube Insertion Site Procedure Breathing Management

Assessment of Chest Tubes Respiratory effort and status Suction versus water seal method Tube placement intact dressing sutures signs of infection loss of tube integrity Breathing Management

X-Rays Breathing Management

Now What ? X-Rays Breathing Management

Assessment of Chest Tubes Adequate drainage quality and amount color changes, blood, pus Adequate suction maintain “dependent loop” milking chest tube placing on water seal adjustments Breathing Management

Do these Work ? Breathing Management

How Good are the Small Tubes ? When can you use a Himlick valve ? Why would you use it ? What can you reasonably expect it to do ? Breathing Management

Complications of Chest Tubes Recurrent pneumothoracies Accidental removal immediately apply occlusive dressing to site do not reinsert tube monitor vital signs closely ventilate prn consider diversion to appropriate facility Breathing Management

Complications of Chest Tubes Broken collection chamber loss of suction can cause open pneumothorax . USE IN AIRCRAFT . UNIVERSAL PRECAUTIONS Breathing Management

Chest tubes scare everyone ATER INSERTION NOW WHAT ? WHO DO YOU ANSWER TO ? WHAT TRAINING IS APPROPRIATE ? Chest tubes scare everyone Conclusion Breathing Management

Some times you really don’t know if you are coming or going but for now we’re done. Thank you for your attention. Breathing Management