Professional Documents
Culture Documents
I – Definition:
-is a surgical opening in the chest wall and inserting. A thoracostomy tube
(chest catheter) is inserted into the chest wall above the area of the second
or third rib. A local anesthetic (xylocaine 1% or 2%) is administered and an
incision is then made into the pleural space of the chest wall. The tube is
inserted, positioned, and clamped, and silk sutures are use to secure the chest
tube in place.
CLOSED-CHEST DRAINAGE
The chest tube leads from the chest via plastic or rubber tubing to a glass
container in which the end of the tube is attached to a glass rod submerged
in water. An air vent allows the escape of air, which bubbles up through the
water. this constitutes the water seal which prevents air from traveling up to the
tube to the pleural space in which negative pressure must develop to re-expand
lung.
TYPES:
• A Simple One - bottle system
It provides water-seal gravity drainage. The gravity system allows
the flow of air or water into the bottle when the pressure in the pleural
space is sufficient to displace the water in the glass rod. The long glass
rod is submerged about 2 cm below the water surface; an intrapleural
pressure greater than 2 cm in the pleural space will be required to
displace it. The reader may demonstrate this concept by taking a drinking
straw and blowing in through the straw while it is submerge in a glass of
water. More effort is required to blow air through the straw when it is at the
bottom of the glass than when it is just slightly under the surface, because
a longer column of water must be displace from the straw. Since the
gravity water-seal drainage bottle is covered with a stopper, the short
glass rod simply serves to allow the escape of air from the bottle. If this
short glass rod becomes occluded, air pressure could build up within the
bottle. This increase pressure pushes the water in the bottle up the long
glass tube toward the chest, risking back flow of fluid into the chest.
• Two – bottle water – seal drainage system
The physician may distinguish among them by briefly clamping the chest
tube near the chest to determine whether bubbling will resumed.
Resumption of bubbling indicates an intact drainage system. The problem
then is an air leak into the pleura from a physiological source. The tube
must not remain clamp as a tension pneumothorax will develop if the air
leak into the pleural space has no egress. Air leaks into the pleural space
may be localize by careful examination of the chest.
• A three-bottle system
It involves the addition of a separate collection bottle so that the
drainage may be separate collection bottle so that drainage may be
measured and inspected as it comes from the chest.
• Pleur-evac
It is a commercially available product incorporating all the features
all ready discussed. It is a single light weight unit which indicates the amount
of air bubbling through the suction chamber from the atmosphere. It calibrates
the exact amount of negative pressure in the pleural space and has a client
leak air flow meter to indicate the amount of air coming from the individual.
II – Purposes:
III – Procedure:
Notify the surgeon if (1) the drainage remains frankly bloody for
longer than the first few postoperative hours, (2) bleeding recurs after it
has slowed, or (3) there are any other manifestation of hemorrhage.
On expiration, air and fluid in the pleural space travel through the
drainage tubing. The air bubbles up through the water seal and enters
atmospheric air. On inspiration, the water seal prevents the atmospheric
air from being sucked back into the pleural space (which would collapse
the lung). The fluid in the water-seal compartment is not drawn into the
chest cavity because the negative pressures generated during inspiration
in the intrapleural space are not high enough to pull the fluid through the
drainage tubing. However, fluctuation of the fluid occurs during respiration;
this fluctuation is called tidaling (tidal movement) or vacillation.
Because air entering the system also enters the pleural space, this
situation must be corrected in the following manner:
Locate the source of the air leak, and repair it if you can. Begin by
inspecting the chest wall where the catheters are inserted.
If the air leak continues, check the tubing, inch by inch, and all the
connections. A break in the tubing or a loose connection may be found
that can be sealed with tape.
3. Suction.
Suction at 10 to 20 cm H2O may be applied to a chest drainage
system if gravity drainage is not adequate or if a client’s cough or
respirations are too weak to force air and fluid out of the pleural space
through the chest catheters.
If the air leak cannot be sealed off (e.g., with petrolatum gauze),
notify the surgeon immediately.
If bubbling does not begin in the suction control chamber when the
chest catheter is clamped, the problem is in the drainage connections or
the regulator. Check the system carefully, looking for loose connections
and for air leaks around the compartment tops and in the tubing (e.g., split
tubing). Make sure that the tubing is not kinked, is correctly positioned,
and has no dependent loops. If the suction power source appears to be
causing the problem, obtain another suction canister and regulator.
RATIONALE:
Surgical wound and chest tube insertion site Wound care varies according to condition of
care incision and client.