becoming a better Clinician
Chest Tube
Used to create negative pressure in the chest cavity and allow re-expansion of the lung
Modalities
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Suction
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actively suctions air and fluid from chest cavity
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pleurodesis/decortication: 24-72 hrs to optimize visceral/parietal pleura
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diaphragm surgery: helps decrease fluid accumulation
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subcutaneous emphysema
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difficult dissection or bleeding concern
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pneumothorax >1cm
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Water seal
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allows air and fluid to escape the chest cavity by gravity
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esophageal surgery: placed near anastomosis in case of leak
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Clamp
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simulates the chest tube being removed to assess for silent airleaks
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silent airleaks: causes increasing pneumothorax or subcutaneous emphysema
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Pleurovac
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First Chamber - Collection Chamber
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blood/fluid collects by gravity and air continues onto 2nd chamber
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Second Chamber - Waterseal chamber
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acts as a one way valve to allow air to escape but not to re-enter the chest cavity
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tidaling: seen in this chamber
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tells you the system is connected to the chest and patent (occurs secondary to begative pressure in the chest) - NORMAL
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changes with inspiration and expiration
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bubbling in this chamber indicates an air leak
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Third Chamber - Suction control
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controls the amount of suction based on the height of the water
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gentle bubbling is normal
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Air Leaks
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most common complication after lung resection
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leakage of air across the alveolar surface of the visceral pleural (alveolar-visceral pleura)
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examine the entire tubing system and wound for any loose connections or slip in the tube
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"jacuzzi water" with bubbles
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continuous
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intermittent
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with cough
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Risk Factors
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steroids
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emphysematous lungs
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re-operation with extensive scar tissue
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Treatment
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80-120cc blood patch into the chest tube self-sealing tubing
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reposition the patient every 20 minutes for 1 hour
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surgicel / gelfoam
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wedged into the airway(s) with leak
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self dissolving in weeks
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bronchial blocker (need a pediatric scope)
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endobronchial valve
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permits air passage during expiration but not during inspiration
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Heimlich Valve: one way valve that allows home discharge; must tolerate waterseal
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re-do surgery
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locate airleaks and remove that portion of lung tissue
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biologic glue placed
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Chest Tube Removal
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no airleak present
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serosanginous output (no signs of bleeding present)
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after epicardial wires have been removed
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output < 150-400cc over 24 hours
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off ventilator positive pressure