Then comes the pleural space, which measures about 15-20 microns wide in its normal state (2). This membrane lines the entire chest cavity. Behind the ribs lies the first layer of the pleural space, called the parietal pleura (2). Between each rib from top to bottom is a vein, artery, nerve, and more muscle (2). Then we come to the ribs, which form the basic protective cage that holds our lungs, heart, and some very important blood vessels. Beneath that is a layer of subcutaneous tissue, followed by muscle. Let’s start with a quick refresher on the structure of our lungs. This course aims to expand your knowledge and increase confidence in chest tube management.Ĭhest Tubes Nursing Care Basics – What Is a Chest Tube? Quick identification of potential complications could be the difference between life and death. Chest tubes nursing care is critical to overall health. Unfortunately, like anything else in healthcare, chest tubes are at risk for complication. Thus, it is essential for nursing staff to feel comfortable with chest tube management. Most nurses will encounter chest tubes at some point during their career– perhaps frequently, depending on where you work. They can be placed just about anywhere– the bedside, the operating room (OR), and interventional radiology. Today, thoracostomy tube (more commonly known as a chest tube) placement continues to be a very common procedure.Ĭhest tubes are utilized for a variety of reasons, ranging from emergent placement to routine use after an elective surgery (1). Though the process and equipment have evolved over the centuries, the basic principles of chest tubes nursing care have not changed (1). In general, a chest X-ray should be obtained any time the chest tube is changed from suction to water seal or vice versa.The ancient Greeks were the first to record techniques used to drain the pleural space (1). A stat chest X-ray should be obtained, and the chest tube should be placed back on continuous suction. If, after the transition from suction to water seal, resumption of the air leak is noted, it may indicate recurrence of the patient’s pneumothorax. Once the air leak has stopped, the chest tube should be placed on water seal to confirm resolution of the pneumothorax (water seal mimics normal physiology). The chest tube should initially be set to continuous suction at -20 mmHg to evacuate the air. If the patient has a pneumothorax, air bubbles will be visible in the water chamber called an air leak, these are often more apparent when the patient coughs.
#PLEUR EVAC ATRIUM SERIAL#
The interventional radiologist or surgeon who placed the tube should determine the subsequent frequency of serial chest X-rays required to monitor the location of the chest tube. Respiratory variation in the fluid in the collecting tube, called “tidling,” should also be seen in a correctly placed chest tube, and should be monitored at the bedside to reassure continued appropriate location.
Chest tubes are equipped with a radiopaque line along the longitudinal axis, which should be visible on X-ray. Chest tubes are also commonly placed at the end of thoracic surgeries to allow for appropriate re-expansion of the lung tissue.Ī chest X-ray should be obtained after any chest tube insertion to ensure appropriate placement. Pneumothorax and hemothorax usually require immediate chest tube placement. Indications for a chest tube include pneumothorax, hemothorax, or a persistent or large pleural effusion. The third chamber is the collection chamber for fluid drainage. The suction chamber can be attached to continuous wall suction to remove air or fluid, or it can be placed on “water seal” with no active suction mechanism. The water chamber holds a column of water, which prevents air from being sucked into the pleural space with inhalation. The tubes are connected to a collecting system with a three-way chamber. Chest tubes are typically placed between the fourth and fifth intercostal spaces in the anterior axillary or mid-axillary line however, the location may vary according to the indication for placement. They can be as thin as 20 French or as thick as 40 French (for adults).
Chest tubes are placed in the pleural space to evacuate air or fluid. The lung re-inflates naturally when this air is withdrawn using the chest drain being inserted here. The lung collapse was done by opening up the pleural cavity to air from outside. The lung was originally collapsed to allow access to the chest organs during surgery. Lung re-inflation after surgery, using a chest drain.
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