CHEST TUBE MANAGEMENT

PROFESSOR JOAN MCMANUS

CHEST TUBESTHORACOSTOMY
 INSERTION OF A TUBE(S) INTO THE PLEURAL CAVITY TO DRAIN AIR OR FLUID   RESTORES NEGATIVE PRESSURE REEXPANDS COLLAPSED LUNG

CLINICAL MANIFESTATIONS OF COLLAPSED LUNG

   DYSPNEA - CHEST PAIN ASYMMETRIC CHEST MOVEMENT q OR ABSENT BREATH SOUNDS ON AFFECTED SIDE MEDIASTINAL SHIFT TACHYCARDIA DULLNESS ON PERCUSSION

  

3 CHAMBER SYSTEM (PLEUROAVAC /THORACLEX

COLLECTION CHAMBER: COLLECTS DRAINAGE 2. H2O SEAL CHAMBER: PREVENTS AIR FROM ENTERING THORACIC CAVITY ON INSPIRATION & ALLOWS AIR TO ESCAPE DURING EXPIRATION. 3. . SUCTION CONTROL: MAINTAINS AMOUNT OF SUCTION 1.

IMPORTANT FACTS
H20 SEAL CHAMBER: 2cmH20 1. FLUCTUATES WITH RESP. EFFORTS

2. PERIODIC AIR-BUBBLES :NORMAL 3. CONSTANT BUBBLING: ABNORMAL

IMPORTANT FACTS
 SUCTION CONTROL CHAMBER CONTAINS STERILE H2O NORMAL AMT. OF SUCTION: 20cm H20 GENTLE BUBBLING p NORMAL NO BUBBLING p  FOR AIR LEAKS

PATIENT CARE WITH CLOSED CHEST DRAINAGE

 PATIENT ASSESSMENT RESPIRATORY ASSESSMENT (BREATH SOUNDS) VITAL SIGNS ABGS PULSE OX CHEST X -RAYS CDB EMOTIONAL SUPPORT

DRAINAGE SYSTEM ASSESSMENT

TUBE INSERTION SITES KEEP SYSTEM q INSERTION SITE TUBING FOR LEAKS & KINKS DRAINAGE FOR COLOR & AMOUNT NORMAL 50 CC PER/HR

CHEST TUBE PRECAUTIONS

1. AVOID MILKING TUBE 2. AVOID CLAMPING EXCEPT DURING PLEUROVAC CHANGE 3. KEEP EMERGENCY CLAMPS NEARBY CLAMPING EXCESS MAY CAUSE TENSION PNEUMOTHORAX POST TUBE REMOVAL STERILE PETROLEUM DRESSING PATIENT ASSESSMENT- CHEST X-RAYS

CHEST TRAUMA
1. FX. RIBS- CONTUSION 2. OPEN / CLOSED WOUNDS 3. FLAIL CHEST: 2 OR MORE FX. RIBS IN MULTIPLE PLACES. PARADOXIC MOVEMENT FLAIL SEGMENT: SUCKED INWARD DURING INHALATION MOVES OUT DURING EXHALATION