Chest tube a hollow plastic tube is inserted between ribs into the pleural space The tube may be connected to a machine to help with the drainage The tube will stay in place until the fluid blood or air ID: 1047290
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1. Chest TubeByA.L. Maher Abdul Ameer
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5. Chest tubea hollow plastic tube is inserted between ribs into the pleural space. The tube may be connected to a machine to help with the drainage. The tube will stay in place until the fluid, blood, or air is drained from the chest.
6. IndicationsFluidPleural EffusionBloodPusSerous FluidAirPneumothorax
7. Pneumothorax
8. Pleural EffusionPusSerousFluidBloodEmpyemaHemothoraxHydrothorax
9. Pleural effusion
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12. PurposesTo remove fluid or air from the pleural spaceTo promote lung re- expantion
13. Equipment Sterile gloves and gown.Skin antiseptic solution (e.g. iodine or 2% chlorhexidine in 70% alcohol)Sterile drapes.Gauze swabs.A selection of syringes and needles (19-25 gauge in adults)Local anesthetic (e.g. lignocaine 1%)Scalpel and blade.Suture kit: Suture (stout and non-absorbable /1.0 - 2.0 silk or prolene)An instrument for blunt dissection if required (curved clamp)Guidewire and dilators for Seldinger techniqueChest tubeConnecting tubeClosed drainage system (under water seal)Dressing equipment may also be available in a kit formChest tube clamps
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15. Preparation for under water seal bottlePut 250-500 ml according hospital policy(Avoid tension pneumothorax)Tube submerged approximately 2cm under waterBottle should be chest level (gravity- no backflow)
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17. Nursing role before insertion chest tubeIdentify PTExplain proceduresHand washingVital singsPrepare the chest tube trayAdministration mild sedation if ordered
18. PROCEDURE
19. Patient positions
20. Elevating the head of a person’s bed by 30–60 degrees. Identifying the tube insertion site. This will typically be between the fourth and fifth ribs or between the fifth and sixth ribs, just behind the pectoralis (chest) muscle.Cleaning the skin with a solution, such as povidone-iodine or chlorhexidine. Using local anesthetic to numb the insertion site. Making an incision of about 2–3 centimeters (cm) through the skin. Using a surgical instrument called a Kelly clamp, widen the incision and gain access to the pleural space. The clamp insertion should be slow to avoid puncturing the lung.
21. Inserting a gloved finger into the incision site. This is to confirm that the area is the pleural space. Inserting the chest tube through the incision site. If fluid begins to drain through the tube, it is in the right place. It is also possible to attach the tube to a chamber containing water that moves when a person breathes. If this does not occur, the tube may need repositioning.Suturing the tube in place so that the seal is as airtight as possible.Covering the tube insertion site with gauze pads.
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27. Apical and basal insertion mid axillary line equal 5 intercostal space
28. Care of patient with chest tubeAssess vital signsSet up drainage system as orderedAuscultate lung sound
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30. Inspect all tubing for leaksKeep chest tube below level of chestIn the event of disconnection, 2 clamps should be kept at bedsideEncourage the pt to cough and deep breathingKeep large clamps bedside when empty or replace abroken or checked bottle systemCheck fluctuation (effusion) and bubbling (pneumothorax)
31. Daily care for patients with chest tube1. Patient activitySemi- fowler position is requiredTurn the PT every 2 hrsPT can be out of bed if there is no contraindicationDo exercises to the affected arm and shoulderEncourage coughing and deep breathing
32. 2. ClampingChanging the bottleTubing is disconnected and sterile water is out of reachIf changing the position and when elevating the tube system above the PT level is requiredDo not clamping: ambulating a patient
33. 3. Milking Milking the tube is not recommended, creates tissue trauma
34. ComplicationsMalposition( organ perforation)Recurrent pneumothoraxInfection (including empyema)Tube blockageHemorrhageSubcutaneous emphysema
35. Don’t be afraid to failJust keep trying
36. CHECK IT