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Chest Tube Thoracostomy

Chest Tube Thoracostomy

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Published by: skyblueali on Mar 16, 2010
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08/05/2013

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CHEST TUBE THORACOSTOMYI – 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 secondor third rib. A local anesthetic (xylocaine 1% or 2%) is administered and anincision is then made into the pleural space of the chest wall. The tube isinserted, positioned, and clamped, and silk sutures are use to secure the chesttube in place. 
TYPES OF CHEST DRAINAGECLOSED-CHEST DRAINAGE
-known as the water seal drainage.-use to restore the negative pressure that has been lost inside the pleuralspace owing to pneumothorax, and to prevent additional air and fluid fromentering the pleural cavity.The chest tube leads from the chest via plastic or rubber tubing to a glasscontainer in which the end of the tube is attached to a glass rod submergedin water. An air vent allows the escape of air, which bubbles up through thewater. this constitutes the water seal which prevents air from traveling up to thetube to the pleural space in which negative pressure must develop to re-expandlung.
TYPES:
A Simple One - bottle system
It provides water-seal gravity drainage. The gravity system allowsthe flow of air or water into the bottle when the pressure in the pleuralspace is sufficient to displace the water in the glass rod. The long glassrod is submerged about 2 cm below the water surface; an intrapleuralpressure greater than 2 cm in the pleural space will be required todisplace it. The reader may demonstrate this concept by taking a drinkingstraw 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 thebottom of the glass than when it is just slightly under the surface, becausea longer column of water must be displace from the straw. Since thegravity water-seal drainage bottle is covered with a stopper, the shortglass rod simply serves to allow the escape of air from the bottle. If thisshort glass rod becomes occluded, air pressure could build up within thebottle. This increase pressure pushes the water in the bottle up the longglass tube toward the chest, risking back flow of fluid into the chest.
 
Two – bottle water – seal drainage system 
It involves the addition of a suction source and a suction-controlbottle. These are added if gravity is not sufficient to clear the air or fluidfrom the chest. The suction-control bottle allows the entrance of air whichbubbles through the column of water in the glass rod, reducing the amountof negative pressure from the suction source. This is sometimes called a
suction-breaking bottle.
When the force of suction exceeds that required todisplace the water inside the glass rod, from the water level down to theend of the glass rod, room air will be drawn into the system to reduce thenegative pressure applied to the chest. Failure of the breaker bottle tobubble means that the desired amount of suction has not been reached.The reasons for this should be investigated. Causes may include a leakwithin the bottle and tube system, an inadequate suction source, and aserious air leak into the pleura from
ruptured bronchus or bronchopleural fistula.
The physician may distinguish among them by briefly clamping the chesttube near the chest to determine whether bubbling will resumed.Resumption of bubbling indicates an intact drainage system. The problemthen is an air leak into the pleura from a physiological source. The tubemust 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 spacemay be localize by careful examination of the chest.
A three-bottle system
It involves the addition of a separate collection bottle so that thedrainage may be separate collection bottle so that drainage may bemeasured and inspected as it comes from the chest.
Pleur-evac 
 
It is a commercially available product incorporating all the featuresall ready discussed. It is a single light weight unit which indicates the amountof air bubbling through the suction chamber from the atmosphere. It calibratesthe exact amount of negative pressure in the pleural space and has a clientleak air flow meter to indicate the amount of air coming from the individual.
II – Purposes:
Remove excess air, blood, or fluid from the pleural cavity,
Reduce the size of the pleural space, and restore negative intrapleuralpressure to promote lung expansion.
Remove tumors of the lung, bronchus or chest wall
Repair or reverse structures contained in the thorax such as open heartsurgery or repair of a thoracic aneurysm.
 
Repair trauma to the chest or chest wall, such as penetrating chestwounds or crushing chest injuries.
Sample a lesion for biopsy.
III – Procedure:
1.
Assess Chest Drainage.
Measure and document the amount of drainage coming from thepleural space in the collection chamber. This record helps determine theamount of blood loss and flow rate of drainage from the pleural space.Disposable plastic systems are manufactured with a marked write-onsurface on which to record the amount of drainage rates and amounts areused in planning blood replacement therapy and assessing client’s status.As much as 500 to 1000 ml of drainage may occur in the next 24 hoursafter chest surgery. Between 100 and 300 amount of drainage mayaccumulate during the first 2 hours; after this time, the drainage shouldlessen. Excessive drainage or a sudden large increase may require further surgery to determine its cause.Normally, chest drainage is grossly bloody immediately followingsurgery, but it should not continue to be so for more than several hours.Assess blood loss by monitoring the rising fluid level in the collectionchamber. Suspect hemorrhage if the pulse rate becomes rapid and theblood pressure drops. Check fluid in the drainage collection chamber. If the fluid level has not risen, check the tunes for patency.Notify the surgeon if (1) the drainage remains frankly bloody for longer than the first few postoperative hours, (2) bleeding recurs after ithas slowed, or (3) there are any other manifestation of hemorrhage.2.
Asses Water-Seal Function.
 A water seal provides a one-way valve between atmosphericpressure and sub-atmospheric (negative) intrapleural pressure. It allowsair and fluid to leave the intrapleural space but prevents the back-flow of atmospheric air into the chest.On expiration, air and fluid in the pleural space travel through thedrainage tubing. The air bubbles up through the water seal and entersatmospheric air. On inspiration, the water seal prevents the atmosphericair from being sucked back into the pleural space (which would collapsethe lung). The fluid in the water-seal compartment is not drawn into thechest cavity because the negative pressures generated during inspirationin the intrapleural space are not high enough to pull the fluid through the

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