Definition of terms: PNEUMOTHORAX -occurs when the parietal or visceral pleura is breached and the pleural space is exposed

to positive atmospheric pressure. TYPES: Simple or spontaneous - occurs when air enters the pleural space through a breach of either the parietal/visceral pleura Traumatic - occurs when air escapes from a laceration in the lung itself and enters the pleural space or enters the pleural space through a wound in the chest wall. Tension - occurs when air is drawn into the pleural space from a lacerated lung or through a small opening or wound in the chest wall. HEMOTHORAX -partial or complete collapse of the lung due to blood accumulating in the pleural space; may occur after surgery or trauma. CHEST TUBES - a catheter inserted through the thorax to remove air or fluid from reentering the pleural space or to reestablished normal intrapleural and intrapulmonic pressures. 2 TYPES Small Bore Catheters (7F-12F) - have one-way valve apparatus to prevent air from moving back into patient. Large-Bore Catheter (up to 40F) - connected to a chest drainage system to collect any pleural fluid and monitor for air leaks. THORACOTOMY - surgical opening into the chest cavity THORACOSTOMY - incision made into the chest wall to provide an opening for the purpose of drainage.

ANATOMY AND PHYSIOLOGY OF RESPIRATIONS

PARTS OF A CHEST TUBE SYSTEM

TYPES OF CHEST TUBE DRAINAGE 1. Traditional Water Seal - also referred to as wet suction - has three chambers; a collection chamber, water seal chamber and wet suction control chamber - it requires sterile fluid to be instilled into water seal and suction chambers - has positive and negative pressure release valves - intermittent bubbling indicates that the system is functioning properly - additional suction can be added by connecting system to a suction source 2. Dry Suction Water Seal - also referred to as dry suction - has three chambers; a collection chamber, water-seal chamber, and wet suction control chamber - requires sterile fluid to be instilled in water seal chamber at 2cm level - no need to fill suction chamber with fluid - suction pressure is set with a regulator - has a positive and negative pressure release valves - has an indicator to signify that the suction pressure is adequate 3. Dry Suctions - also referred to as one-way valve system - has one way mechanical value that allows air to leave the chest and prevents air from moving back into the chest - no need to fill suction chamber with fluid, thus can be set up quickly in an emergency - works even if knocked over, making it ideal for patients who are ambulatory GUIDELINES use sterile water if using chest drainage system with a water-seal when using suction in chest drainage system with a water-seal,fill the suction control chamber with sterile water to the 20 cm level ensure the drainage tubing does not kink, loop, or interfere with the patients movement make sure that the patients body does not compress the tubing gently milk the tubing in the direction of the drainage chamber as needed make sure there is fluctuation tidaling of the fuid level in the water-seal chamber(in wet systems),or check the air leak indicator for leak(dry system with a one-way valve) place the drainage system below the chest level avoid clamping the tube POSSIBLE COMPLICATIONS 1. Continuous bubbling is observed in water-sealed chamber, indicating leak between client and water seal.

Interventions - assess all connections between client and drainage system, and tighten any loose connections - Cross- clamp chest tube close to clients chest. If bubbling stops, air leak is inside clients thorax or at chest tube insertion site. Unclamp tube, and notify physician immediately. Reinforce chest dressing. Leaving chest tube clamped causes a tension pneumothorax and mediastinal shift. - Gradually move clamps down drainage tubing away from client and toward drainage chamber, moving one clamp at a time. When bubbling stops, leak is in section of tubing or connection distal to the clamp. Replace tubing or secure connection, and release clamp. - When an air leak is located, prepare to change drainage system.. 2. Tension Pneumothorax Interventions - determine that chest tubes are not clamped, kinked or occluded. Obstructed chest tubes trap air in intrapleural space when air leak originates within client and can cause a tension pneumothorax -notify clients health care provider immediately -prepare immediately for another chest tube insertion

NURSING RESPONSIBILITIES Before -perform hand hygiene, and assess client -explain the procedure to the patient -provide two rubber-tipped hemostats or approved clamps for each chest tubes, attached to top of clients bed with adhesive tape -position client A .semi-fowlers position to evacuate air (pneumothorax) B .high-fowlers position to drain fluid (hemothorax) During -be sure tube connection between chest and drainage tube is intact and taped -adjust tubing to hang in straight line from top of mattress to drainage chamber After - Perform hand hygiene - Evaluation - Documentation