The quality and appropriateness of care provided under the auspices of the program must be monitored and evaluated by the program's medical director and identified problems must be resolved

CHEST TUBE INSERTION

Involves the surgical placement of a hollow,

flexible drainage tube into the chest.

● Tube is placed between the ribs and into the

space between the inner lining and the outer

lining of the lung (pleural space).

2nd or 3rd intercostal space

2nd or 3rd intercostal space FOR PNEUMOTHORAX

4th to 7th intercostal space

SITES OF TUBE INSERTION for Fluid, blood, pus (both air and fluid)-

Drainage collection chamber

Receives fluid and air from chest cavity

Dry Suction

A valve controls the amount of negative

pressure-no need for water in the suction

control chamber

Water Seal

Acts as one way valve

Suction Control Chamber

Amount of suction is regulated by the

depth of the water not the amount of

suction applied to the system

gravity, positive pressure, suction

3 BASIC PRINCIPLES OF CTT

Tension Pneumothorax

Obstructed chest tubes may result in a

1-2 hours

CHEST tube should be “stripped” or “milked”

every _______ hours accompanied by compressing &

releasing the tube

24 hours

Criteria for CTT removal: No air leak in the last __ in pneumthorax

<200 ml/day

Criteria for CTT removal: Fluid loss is ____ in effusion

PaO2 <55 torr or SaO2 <88%

What is the laboratory finding that may be indication for oxygen therapy in

PAo2 <56-59 torr or SaO2 <88%

laboratory findings in association with specific clinical conditions that may be indication for oxygen therapy

1 to 3 months

Arterial blood 02 should be repeated after how many montsh to determine the need for long-term 02

therapy

Supply Methods

Compressed O2 cylinders

Liquid O2 systems

O2 concentrators

Delivery Methods

Low flow device such as Nasal cannula is most common for long term care -

High-flow device such as air entrainment mask/venturi is often used only when acute exacerbation - O2 conserving devices that decrease O2 use and costs such as transtracheal catheter, reservoir cannula, pulse-flow O2 delivery system (detects inhalation and gives O2)

Bourdon Gauge

Best used for transport

Thorpe Tube

Best used in bedside

Uncompensated

Not recommended for medical use as it

delivers inaccurate flow and increases

risk for hypoxic drive in COPD patients

Compensated

Most recommended for medical use

because of its accuracy.

H cylinder

Usually seen at bedside accompanied with Thorpe tube flowmeter

3.14 L/psig

Cylinder factor for H cylinder

E Cylinder

Used during transport accompanied with Bourdon Gauge Flowmeter

0.28 L/psig

Cylinder factor for E cylinder

-15 cmH2o

If a suction source is connected to the vent tube

in the suction bottle, a negative pressure (not to

exceed -_______) is usually necessary

Oxygen Concentrator

A machine that pulls in the air around you

and filters out the nitrogen.

Liquid Oxygen System

The liquid oxygen supply system usually consists of a bulk storage unit or reservoir that’s housed in a permanent place in the home and a refillable, portable unit that you can carry around

40 liters

A typical bulk storage unit is filled with

approximately of liquid oxygen.