CHEST DRAINAGEPRODUCT TRAINING COURSE

Richard Švec, M.D.

CHEST DRAINAGEPRODUCT TRAINING COURSE

Richard Švec, M.D.

Training overviewTraining overview• Anatomy, physiology and mechanics of Anatomy, physiology and mechanics of

breathingbreathing• Pneumothorax, HaemothoraxPneumothorax, Haemothorax• Principles of underwater seal chest Principles of underwater seal chest

drainagedrainage• From the bottle system to CDUFrom the bottle system to CDU• Chest drainage products (features and Chest drainage products (features and

benefits)benefits)

Anatomy of the Chest CavityAnatomy of the Chest Cavity

Left LungLeft Lung

PericardiumPericardium

IntrapleuralIntrapleuralspacespace

IntrapleuralIntrapleuralspacespace

Right LungRight Lung

TracheaTrachea

DiaphragmDiaphragm

MediastinumMediastinum

Zoom

LungLung

VisceralVisceralpleurapleura ChestChest

wallwall

ParietalParietalpleurapleura

Intrapleural spaceIntrapleural space

Intrapleural SpaceIntrapleural Space

Principles of RespirationPrinciples of Respiration

The pressure of a given quantity of gas is inversely proportional to its volume.

Principles of RespirationPrinciples of Respiration

Increasing volume causes a decrease in pressure, whichcauses air to rush in as the pressures reach equilibrium.

Principles of RespirationPrinciples of Respiration

Decreasing volume causes an increase in pressure, whichcauses air to be expelled as pressures reach equilibrium.

Passive organ (can not make any movements by itself)Needs to be expanded to work

Expansion of the lungs is achieved by:• Negative intrapleural pressure• Lung surface tension

Air inlet/outlet into/from lungs isachieved by:• Increase/Decrease of the volume of the chest cavity (Boyle´s law)

Passive organ (can not make any movements by itself)Needs to be expanded to work

Expansion of the lungs is achieved by:• Negative intrapleural pressure• Lung surface tension

Air inlet/outlet into/from lungs isachieved by:• Increase/Decrease of the volume of the chest cavity (Boyle´s law)

The LungsThe LungsThe LungsThe Lungs

Mechanics of RespirationMechanics of RespirationInspiration process

Air in Contraction of diaphragm and intercostal muscles

Increase of the negative intrapleural presure

Expansion of the lungs

Air inlet to lungsAir inlet to lungs

Air out

Relaxation of diaphragm and intercostal muscles

Decrease of the negative intrapleural presure

Relaxation of the lungs

Air outlet from lungsAir outlet from lungs

Mechanics of RespirationMechanics of RespirationExpiration process

Abnormal ConditionsAbnormal Conditions• Violation of the closed system of the thoracic cavityViolation of the closed system of the thoracic cavity• Loss of the negative intrapleural pressureLoss of the negative intrapleural pressure• Accumulation of air in the intrapleural spaceAccumulation of air in the intrapleural space• Accumulation of fluid in the intrapleural spaceAccumulation of fluid in the intrapleural space

PARTIAL OR FULL LUNG COLLAPSEPARTIAL OR FULL LUNG COLLAPSEDIMINISHED RESPIRATIONDIMINISHED RESPIRATION

TREATMENT NEEDEDTREATMENT NEEDED

!! !!

TerminologyTerminologyPneumothoraxPneumothorax• accumulation of air in the pleural spaceaccumulation of air in the pleural space

HaemothoraxHaemothorax• accumulation of blood in the pleural spaceaccumulation of blood in the pleural space

HaemopneumothoraxHaemopneumothorax• accumulation of air and blood in the pleural spaceaccumulation of air and blood in the pleural space

FluidothoraxFluidothorax• accumulation of any other fluid (matter) in pleural accumulation of any other fluid (matter) in pleural spacespace

HaemomediastinumHaemomediastinum• accumulation of blood in mediastinumaccumulation of blood in mediastinum

• External pneumothoraxExternal pneumothorax Opening in the chest wall. Air directly enters and Opening in the chest wall. Air directly enters and leaves the intrapleural space - open communication.leaves the intrapleural space - open communication. Loss of negative intrapleural pressure. 0Loss of negative intrapleural pressure. 0

• Internal pneumothoraxInternal pneumothorax Opening in the lung. Air enters and leaves intrapleuralOpening in the lung. Air enters and leaves intrapleural space through lung. Loss of negative intrapleural space through lung. Loss of negative intrapleural pressure. 0pressure. 0

•Tension pneumothorax (Valve pneumothorax)Tension pneumothorax (Valve pneumothorax) Opening in the lung or chest wall. Air enters the Opening in the lung or chest wall. Air enters the intrapleural space but can not leave out. Building ofintrapleural space but can not leave out. Building of possitive intrapleural presure. (+) !!!!!!possitive intrapleural presure. (+) !!!!!!

PneumothoraxPneumothorax

PneumothoraxPneumothoraxOpening in chest wallOpening in chest wall

AIRAIR

Loss of the negative intrapleural pressureLoss of the negative intrapleural pressure

Collapse of the lungsCollapse of the lungs

Opening in the chestOpening in the chestwallwall

Trauma, operationTrauma, operation

OpenOpencommunicationcommunication

TraumaTrauma

Opening in the lungOpening in the lung

Loss of the negative Loss of the negative intrapleural pressureintrapleural pressure

Collapse of the lungsCollapse of the lungs

Tension PneumothoraxTension PneumothoraxOne way (valve)One way (valve)Opening in lungOpening in lung

AIRAIR

Risk of building of positive intrapleural Risk of building of positive intrapleural presure !!presure !!Risk of mediastinal shift !!!Risk of mediastinal shift !!!

Pneumothorax, HaemothoraxPneumothorax, Haemothorax

Objectives of treatmentObjectives of treatment

• Removal of airRemoval of air• Removal of fluidRemoval of fluid• Re-building of negative intrapleural pressureRe-building of negative intrapleural pressure

Lung re-expansionLung re-expansion

Pneumothorax, HaemothoraxPneumothorax, Haemothorax

Method of treatmentMethod of treatmentMethod of treatmentMethod of treatment

UNDERWATER SEALTHORACIC DRAINAGEUNDERWATER SEAL

THORACIC DRAINAGE

Underwater SealUnderwater SealChest drainageChest drainage

To the drainage system

•Provides means for air and fluid to escape the chest cavity

•Prevents air from re-entering the pleural space

•Re-establishes intrapleural negative pressure

•Re-expands the lungs

From patient

Water seal

One bottle systemOne bottle system

Air out

For small pneumothoraxuse only !

Risk of progressive resis-tance building by haemothorax.

No control of the situationin the chest cavity.

Two bottle systemTwo bottle systemFrom patient

Collectionbottle

Water seal

Air outSeparation of water sealand collection in 2 bottles elliminates the risk ofprogressive resistance building.

No active suction co-nection recommended.Limited information aboutthe situation in the chestcavity

Three bottle systemThree bottle system

From patient

Collectionbottle

Water seal

Suction controlbottle

Active suction

Three bottle systemThree bottle system

• Separated collection, underwater seal and suction control bottle

• No risk of progressive resistance building

• Exact active suction control

• Limited information about the situation inside the chest cavity

Four bottle systemFour bottle system

Patient assesment bottle

Collectionbottle

Water sealbottle

Suction controlbottle

Active suction

From patient

Four bottle systemFour bottle system

Patient assesment bottle

Collectionbottle

Water sealbottle

Suction controlbottle

Active suction

From patient

Four bottle systemFour bottle system

• Separated collection, underwater seal, suction control and patient assesment bottles

• No risk of progressive resistance building

• Exact active suction control

• Exact information about the situation inside the chest cavity

Bottle systemsBottle systems

•Complicated to assemble and connect to patient•Problem to transport•Made from vulne- rable material•Difficult to monitor

IMPROVEMENTNEEDED

From bottles to CDUsFrom bottles to CDUs

PatientActivesuction

Suctioncontrolchamber

Underwater seal chamber

Collectionchamber

3Ch.CDU system

TYCO Healthcare offers complete line of the chest

drainage units

TYCO Healthcare offers complete line of the chest

drainage units

THORA SEAL I

• Analogy of the one bottle concept• For pneumothorax only• Compact, easy to use• Disposable, break resistant• for gravity drainage only• Self contained floor stand• Ready to use

THORA SEAL II

•Analogy of the two bottle concept•Separated underwater seal chamber and 2,6 litre collection chamber•Easy to read Hi/Low volume graduations (write on)•Integrated floor stand•Strand hanger•Clear PVC connection tubes with anti kink device

THORA SEAL III• Analogy of the 3 bottle concept

• Compact, break resistant

•Removable/Replacable collection chamber with: - Hi/Low volume graduations - White, write-on background

• Unique baffle system prevents fluids from spilling and mixing

•Automatic possitive pressure relief valve

•Build-in hanger, floor stand and tube anti-kink device

•Muffler in suction control

•Self-sealing Kraton patient tube

THORA SEAL III

Aqua Seal

• 3 bottle system concept• Compact, break resistant• Easy to install and use

• Collection chamber: - Paediatric and adult graduations - White, write on background - Kraton self-sealing patient tube - Croppable connector

Aqua Seal

• Underwater Seal Chamber:

- blue coloured water level - Patient assessment graduations - Syrringe for easy filling in - Automatic possitive pressure releif valve - Manual negative pressure relief valve - Water seal access port

Aqua Seal• Suction control chamber: - flow control valve on suction port - Suction control bypass adapter - Wide opening for easy filling in • Other: - Wide 90 degree rot. footstand - Steel hangers - Integrated handle - Setup instructions on unit - Double CSR warp

Aqua Seal

Aqua Seal

Sentinel Seal•Modified four bottle concept•Exclusive „dry“ suction control regulator•Quiet operation•Exclusive patient assesment chamber with blue coloured water level•Automatic possitive pressure releif valve•Filtered manual negative pressure relief valve•Easy to setup and use•Crystal clear, compact

Double SealFour bottle system concept

Collection chamber- 3 column chamber- Hi/low graduation for paediatric and adult use- White, write on background- self sealing collection tube

Underwater Seal chamber- blue coloured water level- patient and/or system air leak control

Double SealSuction control chamber- Bubbling suction controler- blue coloured water level- automatic possitive pressure relief valve

Patient assessment chamber- actual negative pressure readout- continuous monitoring of lung reexpansion process- possitive pressure relief- Automatic negative pressure relief

Patient Assessment - what is the CDU telling me

Tidaling* Bubbling**

Yes Yes

No No

No Yes

Yes No

Large pneumothorax or systemleak - lung still not re-expandedCheck for changesLung reexpansion (slide tidalingcan be observed). Check thecollection tube for kinkingConnection or system leakPinch off the catheter. If the samecheck all connections.Stiff lung desease or patient afterpneumonectomy

Thoracic catheters

•Made from thermosensitive PVC or clear silicone•Sentinel Line and Eye for X-ray possition verification•Smooth finish on tip and eyes•Integral bubble connector for easy connection•Rigid pack container

For open chest application (peroperative)

Trocar catheters

Thoracic catheter intimately seated on aluminium trocar rodTrocar caries the catheter with it as it penetrates the chest wall and enters pleural cavity Colour coded trocars for easy indentifiaction

For closed chest drainage

Safety Shield Trocar cathetersNEW !!!NEW !!!

....a safety trocar thoracic catheter which:• Minimizes the risk of inadverent lung puncture• Provides safe, quick access to the pleural space

Argyle

ThoracentesisExclusive Turkel Safety thoracic punture systemMinimal risk of lung punture and pneuomothorax

Safety canula - withdraws into the shaft during chestwall penetrationAutomaticaly extends when entering pleural spaceSafety color change indicator confirmes the position

Thoracentesis

Pateneted safety valve allows air and fluid to leavethe chest cavity, prevents atmospheric air to enter.

Soft and flexible polyurethane radiopaque catheterwith 1 cm graduations and multiple side holes