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منتدى طلاب جامعة الحديدة


    Chest Tube

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    عاشق فلسطين
    عضو نشط
    عضو نشط

    ذكر
    عدد الرسائل : 65
    العمر : 31
    البلد : فلسطين
    القسم والمستوى : بكالوريوس تمريض
    المزاج : عالي جدا
    أختر علم دولتك :
      :
    السٌّمعَة : 0
    نقاط : 236
    تاريخ التسجيل : 08/09/2009

    بطاقة الشخصية
    تخصصي: تمريض
    المحافظة: الحديدة

    Chest Tube

    مُساهمة من طرف عاشق فلسطين في الجمعة أبريل 15, 2011 11:23 pm

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    Chest Tube & Under Water Seal Apparatus

     it’s a type of Thoracotomy which should be done at the OR

     Insertion:
     Site= 5th ICS mid-axillary line (or anterior-axillary line)

     Timing = when breathing in (As the lung expands & diaphragm goes up & chest wall comes near the lung , so that will push air/bl…etc through the chest tube).

     The tube has a radio-opaque line to make sure the opening is inside the pleura when seen by the CXR

     Steps of insertion:

     Inserted under completely ASEPTIC technique
     Position the pt
     LA if pt is conscious
     Incise the skin b/w 4th & 5th ICS b/w mid- & anterior-axillary line
     (incision is made in the skin and subcutaneous tissues sufficient to admit a finger easily).
     Perform blunt Kelly-clamp dissection over the rib into the pleural space to avoid injury of the neurovascular bundle
     Perform finger exploration to confirm intrapleural placement
     Place the tube posteriorly & superiorly

    - A large bore tube is used for the drainage of blood and fluid, where as a smaller bore tube may be used for the removal of air.
    - The seal must be under chest level, & the chest tube in apex of pleural cavity.
    - The intercostals drainage tube is inserted with the stylette withdrawn (so as not to damage the underlying lung tissue)
    - pressure of suction is -18 cm than water, so the lung will be more expanded
    - The liquid trap is interposed between the tubing existing from the pleural cavity and atmosphere, so :
    o if the pressure in the pleural cavity >atmospheric pressure, air or fluid will be drained out through the water immersed tube.
    o When the pleural pressure becomes negative, atmospheric pressure air is prevented from being sucked into the pleural space by the water seal.
     Duration:

     Leave 3-5 day w/ CXR follow up , then clamp checking for air leak
     If the lung expands on the same day, don’t remove, to allow lung injured area to heal ( instead of removing & inserting several times)

     Techniques for Drainage;

     Open technique: insert chest tube w/o trochar
     Closed technique: with trochar, may injure muscles, vessels

     Indications for insertion:

     Evacuate:
     Air = Pneumothorax (simple, tension)
     Blood = Hemothorax
     Pus = Empyema
     Chyle (lipids) = chylothorax
     Pleural effusion = hydrothorax

     Install medications:
     Chemotherapy
     Abc as in empyema
     post operative



     When should it be clamped??

     disconnection of the tube from the collection device
     changing a full or malfunctioning fluid device
     during removal of chest tube
     if sudden hypotension follows rapid evacuation of a large Hemothorax
     pt w/ Hemothorax with chest tube & you want to send him to CXR ~ clamp the tube to avoid bl from going into the chest again b/c it’s a stagnate blood which stimulates bacterial growth









     Complications:

     Failure of the procedure , e.g. misplacement of the tube in the chest wall
     Injury to:
    • Neurovascular bundle  Hemorrhage, Pain
    • Organ e.g. lung, heart, spleen, liver, esoph ( d/t incorrect position)
     Infection to wound site or pleura (Empyema)
     Introduction of Pneumothorax (while removing or if there was a hole in the tube)


     Care of Chest Tube:

    1- CXR:
    - to check it is correctly inserted
    - to observe lung expansion

    2- Check if it is functioning well:
    - movement of meniscus
    - bubbles in the water

    3- Clamp the tube after 3-5 days, to know if the leak has sealed :
    - if there is still a leak the tube will blow
    - if bubbles stop (no more air in the pleural cavity) Òremove tube (6-24hr)


     Chest Tube Removal:

     Procedure:
    - Sedation
    - Remove all dressings, cut the anchoring suture
    - Cleanse the skin w/ bactericidal solution
    - W/ sterile gloves on, pinch the skin around the tube
    - Have the pt perform Valsalva maneuver, & rapidly remove the tuve while pinching the skin around it to prevent air introduction
    - Apply Abc ointment & cover w/ occlusive dressing
    - Dressing should remain for 24-48 hr
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      الوقت/التاريخ الآن هو الأربعاء أبريل 25, 2018 1:25 am