Management of Chest Tubes

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Management of Chest Tubes Chest tubes are inserted to remove pathological collections of air or fluid in the pleural space, to allow the recreation of the essential negative pressure in the chest, and to permit complete expansion of the lung, restoring normal ventilation. Chest tubes are indicated for pneumothorax (spontaneous, tension, iatrogenic, traumatic), pleural collection (pus from emphyema, blood from hemothorax, chyle from chylothorax, malignant effusions from pleurodesis), post op thoracotomy and video assisted thoracic surgery. Keep patient in a propped up position 45-90 degree. The semi-Fowlers position is useful to evacuate air (pneumothorax). The high-Fowlers position is useful to drain fluid (hemothorax). Adjust tubing to hang in a straight line from the chest tube to the drainage chamber, avoiding excess length and loops. Monitor for blowing or air bubbling in drainage system with quiet respiration and on coughing, type and quantity of drainage. Never lift the drainage system above the level of the patients chest. Keep two clamps (angled) at the bedside. DO NOT clamp a bubbling chest drain. Clamp tubes only for procedures related to the tube or bottle (to change the tube or bottle, to empty the bottle). Avoid kinks in the tube. “Milk” the tube frequently to avoid blockage by fibrin plugs or clots. Change the connecting tube and bottle at least once every 48 hours. (Rajan, Kulkarni 2012) Assure placement by chest x-ray after insertion , monitor vital signs, breath sounds, tracheal deviation, respiratory status, and O2 saturation. (MICUNURSING 2011) Complications of chest tubes, blocked tube due to positioning. Sometimes the tube gets trapped in the major fissure of the lung. If this occurs the tube needs to be withdrawn and reinserted. Cardiac dysrhythmias. Persistent pneumothorax. Failure of the lung to fully

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