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Terminology
Pneumothorax
accumulation of air in the pleural space
Haemothorax
accumulation of blood in the pleural
space
Haemopneumothorax
accumulation of air and blood in the
pleural space
Hydrothorax
accumulation of any other fluid (matter)
in pleural space
PURPOSE
Diagnostic
Therapeutic
Intrapleural Space
Visceral
pleura
Chest
wall
Lung
Zoom
Parietal
pleura
Intrapleural space
INDICATIONS
CONTRAINDICATION
S
DIAPHRAGMATIC HERNIA
PNEUMOTHORAX
HEMOTHORAX
EMPYEMA
CHYLOTHORAX
REFRACTORY
COAGULOPATHY
SEVERE PLEURAL ADHESIONS
FLAIL SEGMENT REQUIRING
VENTILATOR
ASSESSMENT OF
PATIENT
Pulse
Blood pressure
Hypotension
Respiratory rate and
effort
Tachypenia
Bradypenia
Labored
Retractions
Heart sounds--Muffled
(cardiac tamponade),
DIAGNOSTIC AIDS
CLINICAL SUSPICION IN CRITICAL CASES
X-RAY CHEST
FAST ULTRASOUND
CT-SCAN
TECHNIQUE OF
INSERTION
Mostly EMERGENT Placement of tube is
TECHNIQUE
PAINFUL PROCEDURE
Usually done under local anesthesia
May need additional pain killers
PREPROCEDURE PLAN
OBTAIN INFORMED CONSENT
INFORM THE PATIENT POSSIBILITY OF
MAJOR COMPLICATIONS
EXPLAIN THE MAJOR STEPS OF PROCEDURE
MATERIALS NEEDED
Chest tube with / without trocar
ICD TRAY No 11 / 23 Blade with handle, Large
SAFE ZONE
Lateral border of Pectorals major
Horizontal line inferior to Axilla
Anterior border of Lattisimus Dorsi
Horizontal line superior to nipple
5th INTERCOSTAL SPACE
SITE OF INSERTION
PROCEDURE Contd
Local area preparation
Sterile drapings
Incision along the upper border of the rib
Curved Clamp is used to develop the tract & then with the finger
Finger inserted into the pleural space for exploration
Large bore chest tube (3236 F ) is passed along the tract into the
pleural cavity
Tube is connected to underwater seal & secured with sutures
Check x-ray to be taken
effusions
Can be placed with / without trocar
CHEST DRAIN
REENTER
Always be kept below the chest level of the
patient
NEVER CLAMP when there is active air leak in the
One bottle
system
Air out
From patient
Water seal
Collection
bottle
Water seal
Three bottle
system
Patient
3Ch.CDU system
Active
suction
Suction
control
chamber
Collectio
n
chamber
Nursing Responsibilities/Care
of Patient with Chest Tube
NEVER CLAMP AN INTERCOSTAL TUBE: WHY??
BECAUSE TENSION PNEUMOTHORAX
CAN DEVELOP IF
patients chest
Keep tubing patent; make sure no kinks
or clots present
Observe and record amount of
Care of
DRESSINGS:
CHEST XRAY
OBSERVATIONS:
Report immediately chest drainage of >200mls of blood
of the pneumothorax.
lungs
Water / saline
ACUTE
Allergic reaction
Bronchopleural fistula
Cardiac injury
Hemorrhage
Hepatic injury
Infection
Intercostal
neurovascular injury
Lung laceration
Re-expansion
pulmonary edema
Splenic injury
Subcutaneous
emphysema
COMPLICATIONS
LATE COMPLICATIONS
Blockage of tube ( clot / lung )
Retained hemothorax
Empyema
Pneumo thorax after tube removal
Infection
REMOVAL OF ICD
Explain procedure to patient and place in a
position of comfort
Remove sterile dressing. Cut suture
Ask patient to take a deep breath and hold
Then remove the tube and place a sterile
CONCLUSION
Emergency life saving procedure
Maintaining the patency is critical to avoid
complicati0ns
Subcutaneous emphysema clog /insufficient
negative pressure
THANK YOU