1. Chest Tube Management NUR 171

2. Objectives 1.Describe anatomy & physiology of the chest relating to chest drainage 2.Describe conditions requiring pleural chest drainage 3.Describe the purpose and nursing responsibilities related to chest tubes

3. Purpose Chest tubes are utilized in the treatment of emphysema, pneumothorax, chest injuries, or after thoracic surgery for the purpose of: Removing fluid and / or air from pleural space Reducing the size of the pleural space Reestablishing normal negative pressure in pleural space Promoting expansion of lung Preventing reflux of air and or fluid into pleural space from the drainage apparatus

4. Pleural anatomy Lungs are surrounded by thin tissue called the pleura, a continuous membrane that folds over itself Parietal pleura lines the chest wall Visceral pleura covers the lung (sometimes called the pulmonary pleura)

5. Pressure Inflated balloon = HIGH (POSITIVE) PRESSURE Atmosphere = LOW PRESSURE Pop the balloon, and air rushes from an area of high pressure inside the balloon to the low pressure in the atmosphere

7. Condition Requiring Chest Tube Drainage: Pneumothorax Air between the pleurae is a pneumothorax

8. Condition requiring chest drainage: Open Pneumothorax Penetrating Trauma Surgical

9. Condition requiring chest drainage: Tension Pneumothorax Tension pneumothorax occurs when a closed pneumothorax creates positive pressure in the pleural space that continues to build That pressure is then transmitted to the mediastinum: heart and great vessels

10. Condition requiring chest drainage: Hemothorax Blood in the pleural space is a hemothorax

11. Pleural Effusion Transudate or exudate in the pleural space is a pleural effusion

12. Treatment for Pleural Conditions Remove fluid & air as promptly as possible Prevent drained air & fluid from returning to the pleural space Restore negative pressure in the pleural space to re-expand the lung

13. Insertion Preparation Consent for procedure Pre-medicate Thoracotomy tray Chest tube, trocar and a bottle of sterile water Dressing materials - vaseline gauze, antiseptic, foam tape Chest drainage system.Suction

14. Removal of the tube: Chest tube should be removed after A) the tube has been on water seal for ≥24 hours B) the chest tube output is < 150 mLs over a 24 hour period C) the chest radiograph demonstrates that the lung is expanded

15. Chest Tube Assessment S.T.O.P Site Tube Output Patent

16. Nursing Considerations Assessment Monitor suction Position of drainage system Mark output measurement No Milking/stripping