CHEST TUBE

THORACOSTOMY
 CTT stands for Chest Tube Thoracostomy. It's a medical procedure in which a chest
tube is inserted into the pleural space (the space between the lungs and the chest wall) to drain
air, blood, or other fluids from the chest cavity.
This procedure is typically performed to treat conditions such as pneumothorax
(collapsed lung), hemothorax (blood in the chest cavity), or pleural effusion (fluid buildup
around the lungs). The chest tube allows the fluid or air to drain out, helping to restore normal
breathing and alleviate pressure on the lungs.
 Key significances of chest tube thoracostomy:
• Treatment of Pneumothorax - the presence of air in the pleural space, which can cause
lung collapse. This alleviating symptoms such as chest pain and shortness of breath.
• Management of Pleural Effusion - the accumulation of fluid in the pleural space, often due
to conditions such as congestive heart failure, pneumonia, or malignancy.
• Treatment of Hemothorax - a blood accumulation in the pleural cavity, usually resulting
from trauma, injury, or underlying medical condition.
• Management of Empyema - Empyema is a collection of pus within the pleural space, often
secondary to bacterial infection, pneumonia, or lung abscess.
 Types of Bottle System
One-Bottle System:
• In the one-bottle system, there is only a single bottle or chamber involved,
typically serving as a collection chamber.
• The drainage from the chest tube enters this chamber, displacing the water level
and allowing healthcare providers to monitor the volume and character of
drainage.
• There is no separate water seal chamber or suction control chamber in the one-
bottle system. The system relies on passive drainage without suction assistance.
Two-Bottle System:
• The two-bottle system typically consists of a collection chamber and a water seal
chamber.
• Similar to the one-bottle system, the drainage from the chest tube enters the
collection chamber, allowing for monitoring of drainage volume and character.
• The water seal chamber acts as a one-way valve system, allowing air to exit the
pleural space during expiration but preventing air from entering during
inspiration. This helps to maintain negative pressure within the pleural cavity.
Three-Bottle System:
• The three-bottle system includes three separate chambers: a collection chamber,
a water seal chamber, and a suction control chamber.
• As in the two-bottle system, the collection chamber collects the drainage from
the chest tube for monitoring purposes.
• The water seal chamber functions as described earlier, maintaining a one-way
valve system to regulate air movement in and out of the pleural space.
• Additionally, the suction control chamber allows for the application of suction to
enhance drainage. Suction can be adjusted using a dial or regulator to achieve the
desired negative pressure within the pleural cavity.
All systems serve the primary purpose of draining air or fluid from the pleural space, the three-
bottle system offers the additional capability of applying suction to enhance drainage.
PRECAUTIONS:
• Sterile Technique - Maintain strict sterile technique throughout the procedure to minimize
the risk of infection.
• Patient Positioning - the patient is placed in a semi-upright or lateral decubitus position on
the affected side to facilitate drainage.
• Monitoring - Monitor the patient closely during and after chest tube insertion for any signs
of complications, such as respiratory distress, bleeding, or pneumothorax. Continuously
assess vital signs and oxygenation status.
• Securing and Dressing - Secure the chest tube to the skin using sutures or adhesive
dressings to prevent accidental dislodgement. Apply a sterile occlusive dressing around the
insertion site to maintain a closed system and minimize the risk of infection.
 SPIROMETRY
Spirometry is a common pulmonary function test that measures the volume of air that a
person inhales or exhales and the rate at which this volume changes over time. It is a valuable
tool in assessing lung function and diagnosing various respiratory conditions.
Spirometry can provide a baseline assessment of lung function before chest tube insertion. Can
assess lung function, including measures such as forced vital capacity (FVC) maximum
amount of air a person can exhale forcefully after taking a deep breath, forced expiratory
volume in one second (FEV1) volume of air forcefully exhaled in the first second after a
maximal inhalation. FEV1 is a crucial indicator of airflow obstruction., and peak expiratory
flow rate (PEF) used to monitor asthma and assess the severity of airway obstruction..
Provides valuable information about lung function that can aid in the assessment,
management, and monitoring of patients undergoing chest tube thoracostomy.
How to use Spirometry:
• Sit on the edge of your bed if possible. If you can’t, sit up as far as you can in bed.
• Hold the incentive spirometer in an upright position.
• Place the mouthpiece in your mouth and tightly seal your lips around it.
• Breathe in as slowly and deeply as possible. You’ll notice a yellow piston rising toward the top of
the column. The yellow piston should reach the blue outlined area.
• Hold your breath for as long as possible, or at least five seconds. Exhale slowly and allow the
piston to fall to the bottom of the column.
• Rest for a few seconds, and then repeat the first five steps at least 10 times every hour you’re
awake.
• Place the yellow indicator on the side of your incentive spirometer to show your best breath. Use
the indicator as a goal to work toward during each slow, deep breath.
Remember, using the incentive spirometer helps your lungs expand, allowing you to take deep,
full breaths and strengthen your lungs during the healing process.