![]() Secondary pneumothorax occurs because of underlying disease such as emphysema.Ī patient with a pneumothorax usually feels sharp chest pain that worsens on inspiration or coughing because atmospheric air irritates the parietal pleura. A traumatic pneumothorax develops as a result of penetrating chest trauma, such as a stabbing (open) or the chest striking the steering wheel in an automobile accident (closed.) A spontaneous or primary pneumothorax sometimes occurs from the rupture of a small bleb (blister) on the surface of the lung or an invasive procedure such as insertion of a subclavian intravenous (IV) line. A variety of mechanisms cause a pneumothorax. The loss of negative intra-pleural pressure causes the lung to collapse. The space between the visceral and parietal pleura is called the pleural space and is filled with approximately 7 to 20 mL of lubricating fluid to help the pleura slide during respirationģ Trauma, disease, or surgery can result in air, blood, pus or lymph fluid leaking into the intra-pleural space, creating a positive pressure that collapses lung tissue.Ĥ PLEURAL EFFUSION: When a number of clinical conditions such as cancer, infection, pancreatitis, connective tissue disease, autoimmune diseases, asbestos exposure, certain drugs or collagen vascular diseases increase pleural fluid entry or decrease fluid exit from the lung.Ī pneumothorax is collapse of the lung caused by a collection of air in the pleural space. The interior chest wall is lined with a membrane called the partial pleura. The lungs are covered with a membrane called the visceral pleura. The chest cavity is a closed structure bound by muscle, bone, connective tissue, vascular structures and the diaphragm. Routine post removal xrays are not necessary but should be obtained if patient develops new symptoms.Presentation on theme: "NUR 232: Laboratory Handout Chest Drainage Skill - Review"- Presentation transcript:ġ NUR 232: Laboratory Handout Chest Drainage Skill - Reviewįor this power point presentation, I will concentrate on the above skill, along with some background informationĮveryone has a chest cavity. The patient is instructed to exhale or hum continuously during removal to ensure no air in sucked into the pleural space during removal. The chest tube is removed by cutting it, pulling it out, and placing an occlusive tegaderm dressing. If no pneumothorax after the clamping the chest tube, remove the chest tube. If pneumothorax, place the patient on low wall suction and check with an IR attending for the plan. If no pneumothorax, clamp the chest tube with a stop-cock, essentially isolating the drain from the pleurovac box. ![]() Check with an attending for plan.Īfter 2 hours of waterseal, check the follow up radiograph. If there is a persistent pneumothorax, place the patient on low wall suction. Waterseal means that the chest drain is connected to the pleuravac box but the box is not connected to wall suction. If no airleak, leave the patient on waterseal and order a chest xray for 2 hours later. Bubbles escaping into the air leak chamber of the pleurovac box indicate an air leak. Check for airleak by taking patient off suction (turn wall suction off or disconnect tubing connecting the Pleurovac to the wall) and have the patient cough. A 6am radiograph is ordered.īefore rounds, review the radiograph and evaluate the chest tube at the bedside. Below is a common way of managing post-pneumo chest tubes, but always check with your attending with regards to management for a specific patient.Ĭhest tube is left to low wall suction overnight. We typically leave the chest tube on low wall suction overnight to keep the pleura well apposed and promote healing of the pleural puncture. A small, stable pnuemothorax does not require a chest tube but a larger, symptomatic, or growing pneumothorax does. A post biopsy/ablation pneumothorax occurs when air leaks from the aerated lung into the pleural space. ![]() Many chest tubes are placed after outpatient lung biopsy and therefore it is important that we manage the chest tubes efficiently and hopefully have them removed so the patient can be discharged. ![]()
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