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Chest Tube Therapy

   Chest tube is the insertion of tube into the pleural space to drain or evacuate fluid or air from ay of the three compartments; the visceral, pleural space and parietal pleura. The pleural space is located between the visceral and parietal pleura, normally contains 20 ml or less of fluid which helps lubricate the visceral the parietal pleura. Whenever the chest is opened, there is loss of the negative pressure in the pleural space, which can result in collapse of the lungs Indication Pneumothorax Hemothorax Pleural Effusion Chylothorax Empyema accumulating substance Air Blood Fluid Lymphatic Fluid Pus

Indication of chest tube use:
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Sites of for chest tube placement: 1. Pneumothorax (air) – second or third interspace along the midclavicular or anterior axillary line 2. Hemothorax (fluid) – sixth or seventh lateral intercostals space in the midaxillary line.

Assisting with chest tube insertion
Nursing action: (Preparatory phase) 1. Assess the client 2. Obtain chest x-ray 3. Obtain informed consent 4. Verify the right client and right procedure 5. Premedicate if indicated 6. Assemble drainage system 7. Reassure and explain to the patient the steps of the procedure. 8. Position the client (Performance phase) 1. The area of which the insertion must be prepared, anesthetized, and draped. 2. Exploratory needle is inserted 3. IntraCath catheter is inserted through the needle into the pleural space. The needle is remove and the catheter is pushed several centimeters into the pleural space 4. The catheter is tape or sutured to the chest wall and covered with a dressing 5. The catheter is attached to a connector/tubing and attached to a drainage system (Follow-up phase) 1. Observe the drainage system 2. Secure a follow-up chest x r-ray 3. Assess the area of the insertion 4. Maintain the integrity of the chest drainage system

1 inch (2.Types of chest drainage system    1. plus a fluid collection bottle Drainage is similar to that a single unit. Two-bottle water-seal system Consists of the same water-seal chamber. the underwater-seal system is not affected by the volume of the drainage 3. bubbling may or may not be visible. Three-bottle water-seal system Is similar in all respects to the two-bottle water-seal system. which permits drainage of air and fluid from the pleural space. Bubbling can mean either persistent leakage of air from the lungs or other tissues or a leak in the system 2. except that when the pleural fluid drains. except the additional of a third bottle to control the amount of suction applied The amount of suction is determined by the depth to which the the tip of the ventilating glass tube submerged in the water and level f water in the suction chamber or setting of a dial     .5cm) below the level of the water in the container At the end of the drainage tube. One-bottle water-seal system The end of the collecting tube is covered by a layer of water. but does not allow air to move back into the chest Tube from the patient extends approx.