THORACENTESIS AND CLOSED THORACOSTOMY TUBE
NCMB312 (RLE)
BSN 3-Y1-16 | 1ST SEM (23-24)(OLFU-VAL)
THORACOSTOMY
THORACO - LUNGS OSTOMY - BUTAS
CLOSED CHEST DRAINAGE
(THORACOSTOMY TUBE)
PURPOSE:
- to remove air and or fluids from the
pleural space to re-establish negative
pressure and re-expand the lungs
Pleur-evac - the brandname of ctt’s solution
3 WAY SYSTEM - 3 BOTTLES
- (1st and near bottle)
- the collection tube
- pinaka-madumi
- collects pus and blood
- (2nd bottle)
- the water seal bottle
- preventing the air to enter
- (if may excessive bubbling
meaning may air leak)
- gentle bubbling is normal
- (3rd and the last bottle)
- the pressure-regulating bottle
- connected to suction machine
INDICATIONS
1. Pneumothorax
2. Pleural Effusion
3. Chylothorax
4. Empyema
5. Hemothorax
6. Hydrothorax
TYPES OF CTT
1. ONE BOTTLE SYSTEM
- The bottle serves as drainage
bottle and water seal bottle
- Immerse tip of the tube in 2-3cm
of sterile NSS to create water
seal
- Keep bottle at least 2-3 feet
below the level of the chest to
allow the drainage from the
pleura by gravity
- Never raise the bottle above the
level of the chest to prevent
reflux of air and fluid
2. TWO WAY BOTTLE
- Not connected to the suction
bottle
- The first bottle is drainage
bottle; the second bottle is
water seal bottle
- Observe for fluctuation of
fluid along the tube (water
seal bottle) and intermittent
bubbling with each
respiration
- Connected to suction
apparatus
- The first bottle is drainage
and water seal bottle;
- The second bottle is suction
control bottle
THINGS NEED IN BED SIDE
- 2 clamps to use (doctors order)
- extra bottle
- gauze (petrolatum)
NURSING INTERVENTION
FOR ONE BOTTLE
- counting of blood (by ml) per shift
(nurse)
- Normal - 70-100 ml per hr
- If sobra - low bp
- Assess for patency of the device
- Observe for fluctuation of fluid along
the tube
- Observe for intermittent bubbling of
fluid, continuous bubbling means
presence of
- air-leakage
- In the absence of fluctuation:
- There should be continuous, gentle
bubbling in the suction control
chamber.
- This ensures drainage of air and fluids
from the pleural space.
If may wave - Oscillation
- Confirmation - chest X-ray
NOTE!
Encourage to do the following to
promote drainage:
1. Deep breathing and coughing
exercises
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THORACENTESIS AND CLOSED THORACOSTOMY TUBE
NCMB312 (RLE)
BSN 3-Y1-16 | 1ST SEM (23-24)(OLFU-VAL)

2. Turn to sides at regular basis (every PROCEDURE

2 hr)
- Position patient in the siting resting
3. Ambulate (if kaya)
supported on a bedside adjustable
4. ROM exercises of arms
table.
5. Mark the amount of drainage at
- If unable to sit, the patient should lie at
regular intervals
the edge of the bed on the affected
6. Avoid milking and clamping of tube
side with the ipsilateral arm over the
to prevent tension pneumothorax
head and the midaxillary line
7. Removal of chest tube done by
accessible for the insertion of the
physician
needle.
- Elevating the head of the bed to 30
degrees may help.
PREPARE!

- Petrolatum gauze, Suture removal MATERIALS

kit
- Iodine swab
- Sterile gauze, Adhesive tape
- Iodine
- Place client in semi-fowlers position
- Cotton applicator
- Instruct client to exhale deeply and
- Specialize syringe
do valsalva's maneuver as the tube
- Local Anaesthesia - lidocaine
is removed
- Gauze
- CXR may be done after the tube is
- Dressing
removed
- Tape - leucoplast
- Assess for complications:
- Needle to 1L - vacuum bottle ( cause
subcutaneous emphysema,
hypotension)
respiratory distress
- Use largest needle to aspirate

THORACENTESIS (or Pleural Tap) COMPLICATIONS

- it is a procedure in which a needle is - Pneumothorax (3-30%)
inserted through the back of the chest - Hemopneumothorax
wall into the pleural space to remove - Hemorrhage
fluid or air. - Hypotension
- Pulmonary edema due to lung re
PURPOSE: expansion
- Diagnostic - 4to 5 bottle then - Spleen or liver puncture
ipapadala sa lab - Air embolism
- Therapeutic - Introduction of infection

INDICATIONS
NURSING CARE
- Pleural effusion which needs
diagnostic work-up - Sign a consent
- Symptomatic treatment of a large - Mild pain on the site where the needle
pleural effusion was pricked
- Procedure takes only few minutes,
CONTRAINDICATIONS depending primarily on the time it
- Uncooperative patient takes for fluid to drain from the pleural
- Uncorrected bleeding diathesis cavity.
- Chest wall cellulitis at the site of - Inform the client not to cough while the
puncture needle is inserted in order to avoid
- If my infection puncturing the lung

BEFORE THE PROCEDURE:

- The patient may have a diagnostic
procedure, such as a chest x-ray,

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THORACENTESIS AND CLOSED THORACOSTOMY TUBE
NCMB312 (RLE)
BSN 3-Y1-16 | 1ST SEM (23-24)(OLFU-VAL)

chest fluoroscopy, ultrasound, or CT

scan, performed prior to the procedure
to assist the physician in identifying
the specific location of the fluid in the
chest that is to be removed.
- The patient may receive a sedative
prior to the procedure to help the
patient relax.
- Asked the patient to remove any
clothing, jewelry, or other objects that
may interfere with the procedure.
- The area around the puncture site
may be shaved.
- Vital signs

DURING THE PROCEDURE:

- Vital signs (heart rate, blood pressure,
breathing rate, and oxygen level) are
to be monitored during the procedure,
- The patient may receive supplemental
oxygen as needed, through a face
mask or nasal cannula (tube).
- Observe the client for signs of
distress, such as dyspnea, pallor, and
coughing
- Place the patient in a sitting position
with arms raised and resting on an
overbed table. This position aids in
spreading out the spaces between the
ribs for needle insertion. If the patient
is unable to sit, the patient may be
placed in a side-lying position on the
edge of the bed on unaffected side.

AFTER THE PROCEDURE:

- Observe changes in the client's cough,
sputum, respiratory depth, and breath
sounds, and note complaints of chest
pain.
- Some agency protocols recommend
that the client lie on the unaffected
side with the head of the bed elevated
30 degrees for at least 30 minutes
because this position facilitates
expansion of the affected lung and
eases respirations
- Position the patient in a side-lying
position with the unaffected side down
for an hour or longer.

HEMA + EMESIS = HEMATEMESIS (vomiting

of blood)