Managing Patient With Chest Tube

7/18/2019 Managing Patient With Chest Tube

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CLOSED/CHEST TUBE

THORACOSTOMY

AND MANAGEMENT

CHRISTINE MARGARETTE SERRA, RNHEAD NURSE



OBJECTIVES

CHEST TUBE THORACOSTOMY • Anatomy and Physiology of the !ngs

• "e#nition of CTT

• Uses and P!$%oses of Chest T!&es

• "e#nition and Ty%es of 'ate$(Seal"$ainage

CHEST TUBE MA)A*EME)T • P$e%a$ation fo$ Inse$tion

• Ca$e of Patients +ith Chest T!&es

• Remo,al of Chest T!&es

• P$o&lems $elated to CTT and

T$o!&leshooting•



To manage %atient +ith CTT o$

d$ainage safely anda%%$o%$iately the$e&yens!$ing %$o%e$ f!n-tioning of

the -hest d$ainage system.



Ple!$al s%a-es

• %a$ietal and ,is-e$al

• l!&$i-ating /!id

• does not no$mally

-ontain ai$ o$ /!id

e0-e%t fo$ the small

amo!nt of l!&$i-ating/!id

• (1 -m +ate$ on

ins%i$ation and $emain

(2 on e0%i$ation



Site3 ante$io$4 5ndICS4 to $emo,e ai$&e-a!se ai$ $ises

inside the %le!$aand %oste$io$4 1tho$ 6th ICS &e-a!se/!ids tends to /o+

to the &ottom of the%le!$al s%a-e.



To d$ain ai$ o$ /!idf$om the %le!$al-a,ity and allo+

$e(e0%ansion ofthe l!ngs.

To $esto$e theno$mal negati,eint$a(%le!$al%$ess!$e.



"E7I)ITIO)3

a t!&e that is s!&me$ged intoa

-ontaine$ of +ate$ that allo+sai$ to es-a%e th$o!gh a ,ent

&!t %$e,ent ai$ f$omt$a,elling

&a-8 to the t!&e and into the

%le!$al s%a-e. It is %la-ed&elo+ the le,el of the -hest

+hi-h ta8es ad,antage to the

fo$-e of g$a,ity to %$omote a

d$ainage and %$e,ent &a-8

/o+ of the &ottle -ontents



Set(!% mate$ials3

• 1 ste$ile &ottle

• ste$ile no$mal saline sol!tion9+ate$

• $!&&e$ t!&ing

• glass t!&ing inse$ted into a $!&&e$

sto%%e$ :long glass t!&e a-t as a

+ate$(seal and sho$t t!&e a-t as

es-a%e f$om the &ottle th!s %$e,enting%$ess!$e &!ild !%;

)ote3 the <!antity ,a$ies de%ending onthe set(!%



One(Bottle System

( a-t as +ate$(seald$ainage !sing g$a,ityonly

( d!al %!$%ose3 +ate$(sealand -olle-tion-ontaine$

( %$efe$a&ly fo$

%ne!motho$a0 only)ote3 'hen the amo!nt

of /!id in the &ottle isin-$eased &y d$ainage4

mo$e of the t!&e iss!&me$ged -$eating



T+o(Bottle System

( one &ottle is fo$ /!id-olle-tion and theothe$ is +ate$(seal

( the le,el of +ate$(seal&ottle $emains-onstant4 the amo!ntand ty%e of d$ainage

may&e o&se$,ed anddes-$i&ed mo$ea--!$ately.

( g$a,ity of s!-tionmay&e !sed.



Alte$nati,e T+o(

Bottle System

(=st &ottle is fo$/!id -olle-tionand +ate$(seal

( 5nd &ottle is fo$s!-tion -ont$ol



Th$ee(Bottle System

( =st &ottle is fo$ /!id-olle-tion

(5nd &ottle is fo$ +ate$(seal

(>$d &ottle is fo$ s!-tion-ont$ol :it -ont$ols theamo!nt of s!-tiona%%lied to the -hest &ythe s!-tion so!$-e;

)ote3 This is !sed to %$e,entthe %ossi&ility fo$ ahighe$ le,el of s!-tion to&e $ea-hed at the end of

the atta-hed t!&ing ifthe t!&ing is &lo-8ed &y



A -hest d$ainage !nitis an a%%a$at!s fo$s!-tioning gases and

li<!ids f$om the%le!$al -a,ity of%atients. The l!ngs-an &e $e(e0%andedto thei$ no$mal state

to #ll the %le!$al-a,ity &y d$ainingthe li<!id and gasesf$om the int$a%le!$als%a-e !sing a -hest

d$ainage !nit.



THE U)* CE)TER STYE .. .

ACCOR"I)* TO THEBOO? . .



Inse$tion of CTT

Ca$e of the CTT Remo,al of CTT P$o&lems $elated to CTT and

T$o!&leshooting Atta-hment to E(%!m% Con,e$sion to Heimli-h Val,e



E0%lanation of the P$o-ed!$e Consent S-hed!ling P$e%a$ation of mate$ials Baseline Vital Signs



MATERIAS TO

PREPARE . . .

MATERIAS TO

PREPARE . . .

( tho$a-i- -athete$ 52451 o$ >5

( %lasti- -onne-to$

($!&&e$ t!&ing

(glass t!&ing

(ste$ile &ottle =

(ste$ile +ate$9no$mal

saline sol!tion(ste$ile OS 2@2

(ste$ile -otton &alls(&etadine(sil8 5.(0ylo-aine %olyam%!le

5(sy$inges o$ = --.(ste$ile glo,es(dis%osa&le fa-e mas8

(%laste$



Position ( any ofthe follo+ing3

( %atient st$addles

-hai$4 leaning onthe %added &a-8

( %atient sits !%$ightin &ed4 $esting on

o,e$ &ed ta&le( %atient sits at

edge of &ed4leaning on o,e$

&ed ta&le



'hen t$ans%o$ting o$ am&!lating%atient4 ta8e -a$e to3 8ee% the +ate$(seal &ottle !%$ight and

+ate$(seal inta-tD 8ee% the &ottle &elo+ the le,el of the

%atients -hestD and maintain an ai$tight system.



If the -hest t!&e has %!lled o!t3 immediately %la-ean o--l!si,e d$essing s!-h as ste$ile ,aseliniFedga!Fe o,e$ the site to %$e,ent $oom ai$ f$omente$ing the %le!$al s%a-e then -all the %hysi-ian.

In-$ease in &!&&ling +ith ins%i$ation and e0%i$ation3ins%e-t the system in-l!ding ta%e -olle-tion fo$ anylea8.

The %atients an0iety in-$eases3 assess the d$ainagesystem #$st fo$ %$o&lems and the %atients$es%i$ato$y stat!s. If the system is +o$8ing %$o%e$lyand $es%i$ato$y stat!s is sta&le4 s%end time +ith the%atient. E0%lain ho+ the d$ainage system +o$8sand +hy the so!nds of the s!-tion a$e im%o$tantand &ene#-ial.

Patient e0%e$ien-e %ain +hen mo,ing3 medi-ate the



E0%lanation of the %$o-ed!$e P$e%a$ation of mate$ials needed Baseline ,ital signs Positioning Im%o$tant inst$!-tion E,al!ation



Indi-ations3

!ngs has $e(e0%anded and noai$ lea8s a$e %$esent :fo$%ne!motho$a0;

Ple!$al d$ainage of &lood o$%!s $es%e-ti,ely has -eased:fo$ hemotho$a0 and

em%yema;



Mate$ials3

(ste$ile glo,es

(ste$ile &lade9s-isso$s

(ste$ile fo$-e%s

(ste$ile ,aseliniFed ga!Fe

(ste$ile OS 2@2

(&etadine(%laste$



Positioning eithe$ sitting at the edge of the &ed o$lying on the !naGe-ted side.

Im%o$tant inst$!-tion3 as8 the %atient to ta8e a dee%&$eath and &ea$ do+n :,alsal,a mane!,e$; +hile the

%hysi-ian <!i-8ly %!lls o!t the t!&e. The t!&e mayalso &e $emo,ed d!$ing e0%i$ation to %$e,ent ai$ f$om&eing %!lled &a-8 into the %le!$al s%a-e d!$ing the$emo,al of the t!&e.

E,al!ation3 $eass!$e and o&se$,e the %atient

th$o!gho!t the %$o-ed!$e and on the -om%letion ofthe %$o-ed!$e4 a!s-!ltate &$eath so!nds and +at-hfo$ indi-ation of di-!lty of &$eathing4 in-$ease$es%i$ato$y $ate4 -hest %ain and ai$ t$a%%ed in thes!&-!taneo!s tiss!e that -$a-8les +hen %al%ated in

o$de$ to identify -om%li-ations that might o--!$.



The -hest t!&e is atta-hed to a one(+ay /!tte$ ,al,e assem&ly4 +hi-h is

-onst$!-ted so that the /e0i&let!&ing is o--l!ded +hene,e$ the%$ess!$e inside the t!&ing is lessthan the atmos%he$i- %$ess!$e and is%atent +hene,e$ the %$ess!$e insidethe t!&ing is a&o,e atmos%he$i-%$ess!$e.



THE U)* CE)TER STYE . .. 4 ACCOR"I)* TO THE BOO? .

. . 4



Indi-ation3 l!ngs that a$e !ne0%andedand the %atient -an &e dis-ha$gedal$eady

Ad,antages3 sim%le and the f$eedom of%atient f$om the &!l8y d$ainagea%%a$at!s.

Mate$ials needed3:fo$ modi#ed heimli-h,al,e only; s!$gi-al s-isso$. 8elly fo$-e%4 &etadine4

-otton &alls ste$ile glo,es -ondoml ti d &&

Managing Patient With Chest Tube

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