1. 1 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

2. 2 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Chapter 22 Chest Tubes

3. 3 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Chest Tubes: Basic Principles Indications for chest tube placement –Removal from the thoracic cavity of: Blood Pus Pleural fluid Air Mediastinal drains Pleural drains

4. 4 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Chest Drainage System The collection system is divided into three parts: –Collection chamber –Water seal chamber –Suction control chamber

5. 5 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Important Principles of Operation Effects of water level in the water seal chamber Effects of water level in the suction control chamber Vacuum regulation Assessment for leaks

6. 6 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Emergency Management of the Chest Drainage System If the chest tube drainage system becomes disconnected from suction: –prevent air from entering the pleural space If the chest tube becomes inadvertently removed: –cover the incision site with an occlusive dressing

7. 7 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Heimlich Valve A one-way valve attached to the chest tube to prevent air from entering the pleural space –Must remain connected to the chest tube at all times

8. 8 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Assisting with Chest Tube Placement Equipment Required: –Chest tube insertion tray –Sterile gloves –Chest tubes –Local anesthetic –Antiseptic –Chest drainage system –Vacuum regulator

9. 9 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Assisting the Physician with the Procedure Open the sterile chest tube insertion tray Place the patient in a high Fowler’s or semi-Fowler’s position Open the chest tube package Open the sterile petrolatum gauze dressing

10. 10 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Assessment of Chest Tube Placement Obtain a chest x-ray –Verify that the chest tube is located properly –Verify that the chest tube is directed properly superiorly for air inferiorly for fluid

11. 11 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Setup and Maintenance of the Drainage System Setup the drainage system Monitor the drainage system Troubleshoot the drainage system Identify leaks Correct leaks