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Chest Tubes….Just Another Drain. (Yeah right). Caring for a Patient with a Chest Tube. Let’s review some A & P The lungs are wrapped by a double sided envelope of tissue called the _________. The inner most layer is called the _____ _______. The outer most layer is called the ______

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caring for a patient with a chest tube
Caring for a Patient with a Chest Tube
  • Let’s review some A & P
  • The lungs are wrapped by a double sided envelope of tissue called the _________.
  • The inner most layer is called the _____ _______.
  • The outer most layer is called the ______

_______.

how we breathe

How We Breathe….

On inspiration, the lungs move downward.

slide4

The visceral and parietal pleura are separated by a thin film of ________.

On inspiration, the chest wall expands and the diaphragm moves _________.

During inspiration, the pressure within the thoracic cavity is < or > atmosp. pressure so air can rush in the lungs

slide5
During expiration, the intrathoracic pressure is > or < allowing air to exit the lungs.
  • If air or blood is introduced into the pleural space, the normal pressures are disrupted and the lung or lungs will collapse.
  • To drain this air and/or fluid off the pleural space, a chest tube is NEEDED.
indications for chest tube insertion
Indications for Chest Tube Insertion
  • Pneumothorax: Presence of air in the pleural space
  • Hemothorax: Presence of blood in the pleural space
  • Hemopneumothorax: Presence of air and blood in the pleural space
chest tube insertion
Chest Tube Insertion
  • Pneumothorax: Chest tube will be placed at 2nd intercostal space since air ______.
  • Hemothorax: Chest tube will be placed in the 5th/6th or 8th/9th intercostal space since blood and fluid _________.
types of drainage systems

Types of Drainage Systems

Glass Bottle System:

1 bottle

2 bottle

3 bottle

Plastic System:

Thoraseal

Pleuravac

principles of chest tube functioning
Principles of Chest Tube Functioning
  • The idea is to create a one way mechanism that will let air out of the pleural space and prevent outside air from coming in….why would this be a problem?
  • This is accomplished by the use of an underwater seal. The distal end of the drainage tube is submerged in 2cm of H2O.
question
Question????
  • How would the waterseal help in restoring negative intrathoracic pressure??
to clamp or not to clamp
To Clamp or Not to Clamp????
  • What would happen if the chest tube exiting the patient’s chest became kinked or clamped????
  • Would it make a difference if it was a pneumo vs a hemothorax?
tension pneumothorax paging dr carter
Tension Pneumothorax…Paging Dr. Carter
  • Trachea is deviated
  • Decreased or absent breath sounds on affected side
  • Blood pressure drops
  • Tachycardia
  • Dyspnea, Hypoxia, Hypoxemia
  • Decreased Cardiac Output
open pneumothorax
Open Pneumothorax
  • Air enters the pleural space through an actual opening in the chest wall. Can you name some examples of how an open pneumo can occur?
closed pneumothorax
Closed Pneumothorax
  • Air enters the pleural space without any external wound…..originates from within. Can you name some examples which would cause a closed pneumo?
nursing responsibilities care of patient with chest tube
Nursing Responsibilities/Care of Patient with Chest Tube
  • Keep drainage system 2-3 feet below patient’s chest
  • Keep tubing patent; make sure no kinks or clots present
  • Observe and record amount of drainage. >100cc/hr is heavy…notify physician.
  • Encourage TCDB, ambulation as ordered.
when a patient has a chest tube to gravity drainage the nurse should
When a patient has a chest tube to gravity drainage, the nurse should:
  • A. Position the patient on his back
  • B. Restrict the patient of bedrest
  • C. Provide long tubing to reach the suction source
  • D. Keep the drainage chamber below chest level
the nurse knows to clamp the chest tube if
The nurse knows to clamp the chest tube if:
  • A. The drainage unit is disrupted or broken.
  • B. The patient develops a tension pneumothorax.
  • C. Locating a source of an air leak.
  • D. The patient must be transported.