OXYGENATION

Thoracentesis – most common use is Aspiration

 Temporary, Short-Term, Emergency Treatment
 MAD
o Medication Administration (Antibiotics, Chemotherapy, Steroids | Direct Effect)
o Aspiration
o Diagnostic Tests (Biopsy)
 Aspiration
o Pleural Space/Cavity
o Main Goal = Lung Re-expansion | Immediately – 1 to 2 Hours
o Aspirate
 Fluid (treating Pleural Effusion/Pleurisy)
 Blood (treating Hemothorax)
 Pus (treating Empyema)
 Air (treating Pneumothorax | Positive Pressure in Pleural Space causing
Lung Collapse/Atelectasis)
 Access/Insertion Site – Intercostal Space (Side of the Chest)
o Aspirating Air – Between the 2nd to 3rd Intercostal Space (Ideal | 2nd is the Best |
The higher, the better)
o Aspirating Fluid, Blood, and Pus – Between the 5th to 9th Intercostal Space (Ideal
| 9th is the Best | The lower, the better)
 Positioning
o Pre/Intra Procedure
 Side-lying on Unaffected Side (Unconscious) | Preferred for Safety
 Orthopneic Position (Conscious)
o Post Procedure
 Side-lying (Maintain on Unaffected Side for at least 1-2 Hours)
 Puncture Site Up
 If both sides of the chest are affected, Supine, or any neutral position
 Complications
o Infection
o Hemorrhage
 Early Stage – First V/S affected is HR (Tachycardia)
 BP – initially high
 Late Stage – BP is low (Risk for Shock)
o Hypovolemic Shock/Hemorrhagic Shock (>500mL Blood Loss | Risk for Shock)
 Major Shocks
 Cardiogenic (Heart)
 Distributive (Blood is Distributed to Non-vital Organs)
 Hypovolemic (Low Volume of Fluid)
o Pneumothorax
o Subcutaneous Emphysema
 May lead to tissue necrosis
 Can be prevented by putting Pressure Bandage

Chest Tube Thoracostomy/Thoracostomy

 Continuous Drainage of the Pleural Space/Cavity
 Purely for Aspiration/Drainage
 Main Goal = Lung Re-expansion | 3 to 5 Days
 CXR if Lung is still Collapsed
 Chronic Use
 Insertion Site (same with Thoracentesis)
 Positioning (same with Thoracentesis)
 No Milking or Stripping of Tubes
o Risk for Tension Pneumothorax (trapped Air)
 Uses a Bottle System
o 1-Way Bottle System
 2-in-1
 Drainage/Collection
 Water Seal
 Blood, Fluid, and Pus
o 2-Way Bottle System
 2 Bottles
 Collection/Drainage (More Space to Drain)
 Water Seal
o 3-Way Bottle System
 Most Commonly Used Bottle System
 Blood, Fluid, Pus, and Air (Positive)
 3 Bottles
 Collection/Drainage
o <100cc/hr
o <500cc/24H
 Water Seal
 Suction Chamber
 Water Seals
o Submerged >2cm
o Normal Activity: Intermittent Bubbling
 Oscillation
 Fluctuation
 Tidaling
o Inhale – Increase In Water Level
o Exhale – Bubbling
o Watch out for Continuous Bubbling
 Due to Air Leak
 Managements
 Assess the patient first (O2 Status/LOC/VS)
 Locate the Leak (If px is okay | Call MD for Orders of
Temporary Clamping)
 If orders were given, clamp near the chest first, observe
after
o If bubbling stops, the air leak is inside chest cavity
 Call MD for reinsertion
o If bubbling continues
 Clamp towards the bottle
 Replace what needs to be replaced (tube or
bottle)
o Watch out for Stopped Bubbling
 Obstruction (check first)
 Kink, Loop, Secretions, Clot
 Risk for Tension Pneumothorax
 Lung Re-expansion
 Confirm via CXR
 Management
 Assess the patient first (O2 Status/LOC/VS)
 Inspect for Obstruction
  Call MD for Orders of CXR
 Suction Chamber (Negative Pressure)
o Normal Activity
 Continuous Mild Bubbling
o Watch out for:
 Intermittent Bubbling
 Due to Inadequate Suction Pressure
 Strong/Vigorous Bubbling
 Due to Excessive Suction Pressure
o Risk for Tissue Injury