1 When to Use or Not Use By Don Hudson D.O.December 17 CHEST TUBES When to Use or Not Use By Don Hudson D.O. Breathing Management

2 Chest Tubes Indications and purposeDecember 17 Chest Tubes Indications and purpose drainage of fluid and air from pleural space or mediastinum used to treat pneumothorax, hemothorax, hemopneumothorax and empyema (pus) useful in fluid collection helpful in respiratory assistance Breathing Management

3 Positioning Breathing Management

4 . Complications Chest Tube Insertion Site ProcedureBreathing Management

5 Assessment of Chest TubesRespiratory effort and status Suction versus water seal method Tube placement intact dressing sutures signs of infection loss of tube integrity Breathing Management

6 X-Rays Breathing Management

7 Now What ? X-Rays Breathing Management

8 Assessment of Chest TubesAdequate drainage quality and amount color changes, blood, pus Adequate suction maintain “dependent loop” milking chest tube placing on water seal adjustments Breathing Management

9 Do these Work ? Breathing Management

10 How Good are the Small Tubes ?When can you use a Himlick valve ? Why would you use it ? What can you reasonably expect it to do ? Breathing Management

11 Complications of Chest TubesRecurrent pneumothoracies Accidental removal immediately apply occlusive dressing to site do not reinsert tube monitor vital signs closely ventilate prn consider diversion to appropriate facility Breathing Management

12 Complications of Chest TubesBroken collection chamber loss of suction can cause open pneumothorax . USE IN AIRCRAFT . UNIVERSAL PRECAUTIONS Breathing Management

13 Chest tubes scare everyoneATER INSERTION NOW WHAT ? WHO DO YOU ANSWER TO ? WHAT TRAINING IS APPROPRIATE ? Chest tubes scare everyone Conclusion Breathing Management

14 Some times you really don’t know if you are coming or going but for now we’re done. Thank you for your attention. Breathing Management