Professional Documents
Culture Documents
Nursing Collage
Critical Care Nursing (1610-412)
1430 -1431 H / 2010 – 2011
Prepared by:
Ruqayeh Al-Matrouk 207002561
Zahra'a Al-Khabbaz 208001323
Rahamah Al-Shreef 208000758
Batool Al-Shreef 208008491
Fatimah Al-Qaisoom 208007441
Zainab Al-Obeidi 208025617
Sarah Al-Abdali 207000113
Supervised by:
Ms. Khulood Bubshait
Course Coordinator:
Dr. Omnia H. Salem
Care of Patient with Chest Tube
Outlines:
Introduction
Definition of Chest Tube
Purpose
Indications
Chest drainage systems
Types of Chest drainage systems
Two chamber system
Three chamber system
Care of patient with chest tube
Assessment
Drainage monitoring
Water seal monitoring
Positioning
Transporting
Complications
Contraindications
References
Introduction
The normal breathing mechanism operates on the principle of negative
pressure; that is , the pressure in the chest cavity normally is lower than the
pressure of the atmosphere causing air to move into the lung during
inspiration.
Trauma, disease, or surgery can interrupt the closed negative-pressure
system of the lungs, causing the lung to collapse. Air or fluid may leak into
the pleural cavity. A chest tube is inserted and a closed chest drainage
system is attached to promote drainage of air and fluid. Chest tubes are
used after chest surgery and chest trauma and for pneumothorax or
hemothorax to promote lung re-expansion.
Chest tube ( chest drain):
A chest tube is a drain placed into the pleural space to restore intrapleural
pressure and reinflate the lung after it has collapsed. It also acts to prevent
fluid and air from returning to the chest. Chest tube maintenance includes
the actions performed by the nurse or other health care professional to
keep the tube functioning properly.
Purpose:
remove air ,fluid or even blood from pleural space.
allow the lung to re-expand after collapsed or after partial collapsed.
prevent reflex of drainage back into the chest.
Indications:
Empyema: infection of the pleural space (usually following pneumonia)
Hemothorax: blood in pleural space, May caused by traumatic (forceful)
chest injury, a tumor (growth) of the pleura, or bleeding problems.
Pleural effusion: fluid in the pleural space(pleural effusion) usually
caused by heart failure, infection or tumors .
Pneumothorax: air in the pleural space.
All these causes not allowing the lung to fully expand when breathe.
Which need immediate intervention
Positioning:
Ideal positioning for chest tube is semi-fowler’s
Turning the patient every 2 hours to enhance air and fluid evacuation
Encourage breathing and coughing exercises and ambulation
Administer of analgesic before these exercises
Teach the patient to splint the chest wall by below or cross fingers
during breathing exercise, coughing or sneezing to avoid pain.
Transporting:
Constant assessment during transporting should be done to prevent
inadvertent chest tube removal (causing recurrent pneumothorax)
Maintain chest drainage system integrity by positioning it below
chest level and secure it to the foot of the bed
The suction must be implemented
Check for air leak, dressing, water seal integrity, water level and
drainage
Complications:
most serious complication resulting from tube placement is tension
pneumothorax rustling from obstruction in the drainage system
bleeding from an injured intercostals artery (running from the aorta)
accidental injury to the heart, arteries, or lung resulting from the chest
tube insertion
local or generalized infection from the procedure
persistent or unexplained air leaks in the tube
dislodged or inserted incorrectly
insertion of chest tube can cause open or tension pneumothorax
Puncture of liver or spleen. This is entirely preventable; insertion site is
in the nipple line, between 4th and 5th ribs!
Passage of tube along chest wall instead of into chest cavity. In this case,
widen and deepen the dissection between the ribs, and make sure the
insertion of the tube follows this path
Contraindications:
Refractory coagulopathy,
Lack of cooperation by the patient,
Diaphragmatic hernia.
Scarring in the pleural space (adhesions)
Infection over insertion site
Uncontrolled bleeding diathesis
Reference:
Suzanne C. Smeltzer, Brenda G. Bare, Janice L. Hinkle and Kerry H. Cheever,
2008: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, Eleventh
Edition, Lippincott Williams & Wilkins
Gonce P. Morton and Dorrie K. Fontaine,2009: Critical Care Nursing a holistic
approach Ninth Edition, Lippincott Williams & Wilkins
Nettina, Sandra M.; Mills, Elizabeth Jacqueline,2006: Lippincott Manual of
Nursing Practice, 8th Edition, Lippincott Williams & Wilkins
Carol R. Taylor, Carol Lillis, Priscilla LeMone, Pamela Lynn, 2008: Fundamentals
of Nursing The Art and Science of Nursing Care , Sixth Edition, Lippincott
Williams & Wilkins
www.drugs.com/cg/chest-tubes.html
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