care of patient with chest drainage system
TRANSCRIPT
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Care Of Patient With
Chest Drainage System
By:
Mr. M. Shivanandha Reddy
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What Is Chest Tube?
• A chest tube is a catheter inserted through the thorax to remove air and fluids from the pleural space, to prevent air or fluid from re-entering the pleural space, or to Re-establish normal intrapleural and intrapulmonic pressures
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Chest Tube
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Indications:
• Pneumothorax• Hemothorax• Pleural Effusion
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Pneumothorax
Air between the pleurae is a Pneumothorax• Occurs when there is an
opening on the surface of the lung or in the chest wall — or both
• The opening allows air to enter the pleural space between the pleurae
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Hemothorax
Blood in the pleural space is a Hemothorax
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Pleural Effusion
•Pleural Effusion–Transudate –Exudate –Empyema
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Purpose Of Chest Tube Placement:
1. Remove fluid & air as promptly as possible2. Prevent drained air & fluid from returning to
the pleural space3. Restore negative pressure in the pleural
space to re-expand the lung
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1. Remove Fluid & Air As Promptly As Possible
• Correctly positioned chest tube removes the fluid and air that is accumulated because of hemothorax or pneumothorax or pleural effusion
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Prevent Drained Air & Fluid From Returning To The Pleural Space
Chest tube is attached to a drainage device – Allows air and fluid to leave the chest– Contains a one-way valve to prevent air & fluid
returning to the chest– Designed so that the device is below the level of
the chest tube for gravity drainage
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Restore negative pressure in the pleural space
• Chest tube will be connected to a suction through 3 bottle system that maintains negative pressure in the pleural space
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How A Chest Drainage System Works:
• Expiratory pressure from the patient helps push air and fluid out of the chest (cough, Valsalva Manuer)
• Gravity helps fluid drainage as long as the chest drainage system is below the level of the chest
• Suction can improve the speed at which air and fluid are pulled from the chest
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Types Of Chest Drainage Systems
• The most commonly used drainage systems are:
1. One bottle / single bottle system2. Two bottle system3. Three bottle system
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One Bottle / Single Bottle System
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One Bottle / Single Bottle System• The simplest closed drainage system is the single
chamber unit.• The chamber serves as a fluid collector and a water
seal. • During normal respiration the fluid in the chamber
ascends with inspiration and descends with expiration.
• This is used for smaller amounts of drainage such as an empyema
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Two Bottle System
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Two Bottle System• The use of two chambers permits any fluid to
flow into the collection chamber as air flows into the water-seal chamber.
• Fluctuations in the water-seal tube are anticipated.
• Two chambers allow for more accurate measurement of chest drainage and are used when larger amounts of drainage are expected.
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Three Bottle System
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Three Bottle System• When a volume of air or fluid needs to be
evacuated with controlled suction, all three chambers are used.
• Mark the suction control with centimeter readings to adjust the amount of suction.
• Usually 15 to 20 cm of water pressure is used for adults
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Pleuro Vac
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Pleuro Vac
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Precautions To Be Taken For A Patient With Chest Tube:
• Keep a chest tube system closed and below the chest
• The tube should be secured to the chest wall.• Watch for slow, steady bubbling in the suction-
control chamber and keep it filled with sterile water at the prescribed level.
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……. Precautions
• Make sure that the water-seal chamber is filled to the manufacturer specified level and watch for fluctuation (tidaling) of the fluid level to ensure that the chest tube and system are working.
• Make sure connections are tight and taped• Report any unexpected cloudy or bloody
drainage.
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……. Precautions• A constant or intermittent bubbling in the
water-seal chamber indicates a leak in the drainage system, and the health care provider must be notified immediately.
• Mark the level on the outside of the collection chambers every shift.
• Do not let the tubing kink or loop, and ideally it should lie horizontally across the bed or chair before dropping vertically into the drainage device.
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……. Precautions
• Encourage your patient to cough, deep breath, and use the incentive spirometer.
• Make sure that he or she is frequently repositioned and ambulated if not contraindicated.
• Routinely assess respiratory rate, breath sounds, SpO2 levels, and the insertion site for subcutaneous emphysema
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……. Precautions• Clamping a chest tube is contraindicated when
ambulating or transporting a patient. Clamping can result in a Tension Pneumothorax
• Handle the chest drainage unit carefully and maintain the drainage device below the patient’s chest.
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If The Tubing Disconnects From The Drainage……
• Seal off insertion site – dry, sterile dressing or, petroleum gauze dressing
• instruct the patient to exhale as much as possible and to cough. This maneuver rids the pleural space off as much air as possible.
• Temporarily re-establish a water seal by immersing the open end of the chest tube into a container of sterile water
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Termination of Chest Tube• Explain procedure to patient • Equipment– Suture removal kit, gloves, Vaseline gauze,– 4x4s, tape, towels
• Tube should be pulled at the end of full inspiration.
• Some physicians prefer coughing or holding breath to increase intrathoracic pressure
• Occlusive dressing
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