C H E S T T U B E S ORIENTATION 2005

A Little History Chest tubes has a history as far back as B.C. to drain pus from the pleural sac surrounding the lungs. In 1876, a system was developed for continuous drainage into a jar filled with anti septic. It was not until the Korean war that chest tubes were used routinely.

Importance & Purpose Used to drain blood, fluid, or air Prevents collapsing Enables the lung to re-inflate Relieves pain Used to manage life threatening situations

Incidence & Cause Air pressure build up in chest --- the lung collapsed Air build up in chest cavity --- the heart moves to opposite side of chest cavity Blood build up in chest cavity Air & blood build up in chest cavity with no improvement Chest wound with sucking Pus in chest cavity Fluid build up w/ s&s of bacteria, high acid content, low sugar content or high enzyme content

Fatty white fluid present (Chyle) Clot busting drugs needed to remove clots from lungs.

Insertion / Placement Pain / comfort measures to the patient A small incision between 4th & 5th ribs. Small semi rigid tube is inserted and stitched into place Tube is placed to a drainage system Occlusive dressing is applied to insertion site An X ray is taken to confirm placement

COMPLICATIONS Infection of surgical site (tube removed and antibiotic begin) Bleeding ( replace tube) Blood Clots from trauma Re-expansion pulmonary edema (can be fatal) Tube kinking Improper placement Tube plugging

Care of Patient with Chest Tube Pre-Insertion –Assess pt breath sounds, HR, BP, RR and rhythm, and O2 Sat –Assure O2 and suction at bedside –Pain & comfort measures

Post Insertion, Maintenance Assess patient breath sounds, HR, BP, T, RR and rhythm, O2 Sat, and comfort Obtain X ray for placement confirmation Assess insertion site, location and tube size Check for fluctuations in air leak indicator Check for air bubbles Check for correct suction set level as ordered

Check drainage for amount, color, consistency Check dressing for occlusiveness and drainage Check chest wall at insertion site for subcutaneous emphysema Must keep the drainage system upright Secure the tubing as not to pull or tug and drainage is gravital

Reposition infant as tolerated and per policy Change dressing as ordered When clamping the tube, a padded hemostat is used