Lab: Chest tubes

purpose of chest tubes

• Remove air, blood and/or fluid
• Restore negative intrapleural pressure, allowing the lung to re-expand

where can the chest tube be placed

May be inserted into any of the three thoracic compartments

• right pleural space

• left pleural space

• mediastinum

how does the placement matter

• higher/anterior for air removal (air rises) commonly through 2nd intercostal space

• lower/posterior for fluid removal (fluid settles) commonly Posterior through 8 or 9th intercostal space in mid-axillary line

Indications for chest tube

• Peumothorax
• Hemothorax
• Pleural effusion
• Empyema
• Post thoracic surgery

The Pleural Space is ?

• Space between ribs and lungs

• Filled with small amount of fluid

• Air or fluid in pleural space inhibits expansion and breathing

how are chest tube placed ?

• where

• meds?

• secured how

• what kind of dressing

• must take ?

• in OR/ ER/ PACU or bedside

• local anesthesia or sedation

• sutured to chest wall

• Occlusive dressing (saturated with petroleum to prevent air from passing through) over insertion site

• must take pre and post vitals and pain assessment

what kind of drainage system is used

• dry vs wet?

water seal mechanism - one way valve allowing air/fluid out of the pleural space but preventing air from moving back in

• dry - no water in suction chamber, but still water in water seal chamber

• wet - water in suction chamber & water seal chamber

what are the 3 chambers

• what controls suction

• farthest R: collection chamber - collects fluid/ air from pt

• middle: water seal chamber - creates seal (must have 2cm of water filled up)

• farthest L: suction chamber - attached to suction and regulates amount of suction

• wall suction does not determine suction pressure, the suction chamber does

• either dial (dry system) or column (amount) of water (wet system)

what are we looking for in the water seal chamber

• good or bad

• what is normal in the suction chamber

• we want to see tidaling (rise & fall of water) - indicating intake and exhale

• if we do not see tidling, could be an obstruction or the lung re-expanded and ready to be taken out

• we do not want to see bubbling - indicates leak

• bubbling is normal to see in the suction chamber of a wet system

managing a chest tube

• where do we keep

• ensure line is ?

• never?

• monitor and document ?

• always keep below the level of the chest to drain effectively

• ensure line is not kinked or occluded

• never clamp without an order

• monitor and document drainage - amount , color, consistency

• report any increase or cessation in drainage

what should always be at the bedside

• extra drainage set up

• oxygen

• suction

• sterile occlusive dressing

• 2 enclosed hemostats (clamps)

• bottle of sterile water

complications of a chest tube

• infection

• pnuemothorax

• subcutaneous emphysema

when do we remove chest tube

• how do we confirm chest re-expansion?

• vitals ?

• for pain?

• pace when removing

• what kind of dressing

• pleura and chest wound healing ?

• when tidaling stops & chest x-ray confirms re-exapansion of the lung

• vitals improve - RR normal easy breathing, normal O2 sat, symmetrical chest expansion

• pre-medicate for pain

• breathe in & hum out (tell to to practice)

• removed quickly

• oclusive dressing over insertion site

• pleura seals itself off & chest wound heals in a week