Skills Lab Tracheostomy and Chest tubes

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Skills LabTracheostomy and Chest tubes

• Tracy Petleski, MSN

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Chest TubesGoals

• Improve airway clearance
• Improve gas exchange breathing
• Reduce risk atelectasis or pneumonia
• Pneumothorax
• Relieve pain discomfort

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Chest TubesIndications

• Thoracic surgery
• Trauma
• Pnuemothorax

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Location of chest tube placement

• Pnuemothorax
• Chest tube is placed in upper anterior chest
• Pulmonary effusion or pulmonary infiltrate
• Chest tube is placed in lower anterior chest

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Types of Drainage Systems

• Water seal drainage system
• Dry suction drainage system
• In the water-seal drainage system suction is
  determined by the amount of water in the water
  seal system and the amount of suction on the wall.

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Chest tubes

• Water-seal drainage system
• One-way valve
• Removal of pleural drainage
• Increases intrathoracic pressure
• Decreases chest wall pressure
• RESTORATION OF NEGATIVE PRESSURE IN THE LUNGS

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Water-seal system

• Increases rate flow of fluid/ drainage
• Increases rate air volume to maximize lung
  expansion

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Dry drainage system

• Closed system
• One-way drainage system
• Thoracic pressure the pressure of wall suction
  the level of water in the suction drainage
  system
• Wall suction controls the rate of air flow

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Nursing considerations- chest tubes

• Auscultate breath sound, rate, rhythm depth
• Oxygen therapy measure O2 saturation pulse O2
• Telemetry, rate, rhythm changes
• Cap refill,skin color, mental status
• Turn, cough deep breath
• Pain management

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Nursing diagnosis

• Inadequate gas exchange
• Ineffective airway clearance
• Acute pain
• Impaired mobility
• Possible fluid imbalance
• Possible nutrition
• Knowledge deficient

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Potential problems with chest tubes

• Chest tube is pulled out
• Tubing becomes disconnected
• Tubing becomes kinked
• Drainage system failure
• Drainage system spills
• Wall suction fails

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Potential complicationschest tubes

• Respiratory distress
• Dysrhythmias
• Atelectasis, pnuemothorax, fistula
• Blood loss or hemorrhage
• Pulmonary edema

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Nursing responsibilities

• ALWAYS check patient first
• ALWAYS check equipment
• ALWAYS check suction source
• Confirm findings with another RN and call
  physician

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Nursing responsibilities

• Assessment of pt.s respirations O2 saturation
  levels, mental status
• Monitor and document amount of drainage from
  chest tube
• Monitor pt.s tolerance of chest tube
• Document findings. Amount of drainage, bubbling,
  chest tube site and appearance of dressing.

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Nursing responsibilities

• Stop-cock valve must remain open at all time
• Drainage system MUST be below the level of the
  chest

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Tracheostomy

• Surgical procedure often referred to as a
  surgical airway
• Opening in trachea is called an stoma
• Indwelling tube is placed below vocal cords
• Permanent or temporary

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Possible reasons for placement of a tracheostomy

• Bypass upper airway obstruction
• Remove tracheobronchial secretions
• Permit long-term ventilation
• Prevent aspiration
• Replace an endotracheal tube
• Emergency-protect airway

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Tracheostomy

• Cuffed tube
• Breathing occurs only through the tube. There is
  no passage of air passed the vocal cords. Talking
  is not possible without an aid
• Un-cuffed tube
• Breathing occurs around the tube. The patient has
  the ability to talk.

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Special considerations with a tracheostomy

• Air is no longer humidified or filtered
• Avoid the use of fiberious tissues or clothing (
  risk of aspiration)

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Complications of tracheostomy

• LOSS OF AIRWAY
• INFECTION
• Bleeding
• Pneumothorax
• Air embolism
• Aspiration
• Subcutaneous or mediastinal emphysema
• Nerve damage
• Posterior wall penetration

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Complication of tracheostomy

• Chronic tracheostomy
• Fistula
• Necrosis
• Nerve damage

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Nursing responsibilities-trach

• Continues monitoring
• Assessment
• Elevate HOB
• Monitoring secretions
• Suction
• Anxiety
• Communication

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Nursing responsibilities

• Teaching
• Trach care
• Oral hygeine
• Tube management
• Suctioning
• Replacing tube
• Emergencies