chest tube insertion
DESCRIPTION
Chest Tube Insertion stase bedahTRANSCRIPT
Thoracic Cavity
Batas – batas cavitasthorax• Anterior = sternum• Posterior = vertebra
thorakal• Lateral = ribs• Inferior = diafragma
Breathing : Inspirasi
• Diafragma berkontraksi, vol cav thorax ↑, tekanan intrapulmoner ↓
• Udara dari luar memiliki tekanan lebih tinggi masuk ke paru yang tekanannya lebih rendah
Breathing : Ekspirasi
• Diafragma relaksasi, vol cav thorax ↓ tekanan intrapulmoner ↑
• Udara mengalir keluar dari paru menuju ke luar yang tekanannya lebih rendah
Pleural Anatomy
Paru – paru dilapisi oleh pleura• Parietal pleura : melapisi dinding dada• Visceral pleura : melapisi paru ˗ paru• Ruang diantara kedua pleura disebut spatium
pleura atau cavum pleura
Thorax Tube
• Tube thoracostomy, thoracic catheter, chest drain, intercostal drain
• “Adalah sebuah selang elastis yang dimasukkan pada cavum pleura melalui dinding dada untuk mengeluarkan udara, darah, pus, dan cairan lainnya”
Kontraindikasi Pemasangan Thorax Tube
• Infeksi pada lokasi pemasangan• Gangguan pembekuan darah yang tak terkontrol
Equipment• Chest tube drainage device with
water seal• Suction source and tubing• Sterile gloves• Preparatory solution• Sterile drapes• Surgical marker• Lidocaine 1% with epinephrine• Syringes, 10-20 mL (2)• Needle, 25 gauge (ga), 5/8 in• Needle, 23 ga, 1.5 in; or 27 ga, 1.5
in; for instilling local anesthesia• Blade, No. 10, on a handle• Large and medium Kelly clamps
• Large curved Mayo scissors• Large straight suture scissors• Silk or nylon suture, 0 or 1-0• Needle driver• Vaseline gauze• Gauze squares, 4 x 4 in (10)• Sterile adhesive tape, 4 in wide• Chest tube of appropriate size
Man - 28-32FWoman - 28FChild - 12-28FInfant - 12-16FNeonate - 10-12F
Memposisikan Pasien
• Posisikan pasien dalam keadaan supine atau 45o
• Abduksikan lengan dan rotasikan eksternal lalu letakkan telapak tangan di belakang kepala
Langkah Pemasangan Thorax Tube
Skin preparation and marking.The skin incision is made in between the midaxillary and anterior axillary lines over a rib that is below the intercostal level selected for chest tube insertion.
Langkah Pemasangan Thorax Tube
Skin incission approximately 4 cm long Should be in the same direction as the rib itself
Langkah Pemasangan Thorax Tube
Palpation of the selected intercostal space and the superior margin of its inferior rib
Langkah Pemasangan Thorax TubeA closed and locked Kelly clamp is used to enter the chest wall into the pleural cavity. Make sure to guide the clamp over the upper margin of the rib.
Once the Kelly clamp enters the pleural cavity, the clamp should be opened to further enlarge the opening.
Langkah Pemasangan Thorax Tube
A finger is used to palpate the tract and feel for adhesions before insertion of the chest tube.
Langkah Pemasangan Thorax Tube
The proximal end of the chest tube is held with a Kelly clamp that is used to guide the chest tube through the tract.
The distal end of the chest tube should always be clamped until it is connected to the drainage device.
Langkah Pemasangan Thorax Tube
A 0 or 1-0 silk or nylon suture is used to secure the chest tube to the skin.
Apply petrolatum (eg, Vaseline) gauze over the skin incision.
Langkah Pemasangan Thorax Tube
Apply support gauze dressing around the chest tube and secure it to the chest wall with 4-in adhesive tape
Chest tube in good position.
Thorax Drainage System
• Hanya bisa digunakan untuk pneumothoraxTube open to
atmosphere vents air Tube from patient
Thorax Drainage System
• The first bottle collects the drainage
• The second bottle is the water seal
• With an extra bottle for drainage, the water seal will then remain at 2cm
Tube open to atmosphere vents air
Tube from patient
Thorax Drainage System
Fluid drain
Tube from patient
Tube open to atmosphere vent air
Tube to vacuum source
Straw under 20cm H20
Thorax Drainage System
• Keep drain below the chest for gravity drainage
• Fluid, like air, moves from an area of higher pressure to an area of lower pressure
Komplikasi Pemasangan Thorax Tube
• Improper placement• Perdarahan• Hemoperitoneum
liver atau splen injury, segera laparotomy emergency
• Penetrasi organbiasanya membutuhkan repair surgery
Komplikasi Pemasangan Thorax Tube
• Tube dislodgement• Empyema
chest tube bisa mengakibatkan masuknya bakteri ke cavum pleura
• Retained pneumothorax atau hemothorax
Reference
• Gil Z Shlamovitz. 2014.Tube Thoracostomy. Diakses dari http://emedicine.medscape.com/article/80678
• Queens university. 2012. Tube Thoracostomy. Queens University : Dept. Of Emergency Medicine
• American Thoracic Society. 2013. Chest Tube Thoracostomy. Respir Crit Care Med Vol. 170