Simulation Chest Tube-Level 2

Simulation Chest Tube-Level 2 - Lindsey Ellett NU 304 Chest...

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Lindsey Ellett NU 304 Chest Tube Simulation http://www.nlm.nih.gov/medlineplus/ency/article/002947.htm 1. Discuss the rationale for why clamping of chest tubes is no longer advocated as routine clinical practice. No chest tube is clamped except under direct observation prior to removal or with physician’s orders. Clamping the tube can allow a tension pneumothorax  to develop due to pressure build up in the pleural space. The risk is increased when a patient is receiving positive pressure ventilation. (pg. 991 Osborn) Chest tubes are only clamped off under specific circumstances per physicians orders: Assess air leak Quickly change or empty disposable systems Accidental disconnection drainage tubing from drainage collection device or damage to the device Assessing patient readiness for chest tube removal If large amount of air trapped between pleural layers, tension in the area increases causing the mediastinum to be pushed toward unaffected lung which  cause the lung to partially collapse which compromises venous return to the heart (tension pneumothorax). Potter pg. 952,955 2. What are four clinical manifestations of a pneumothorax? The specific manifestations depend on the size of the pneumothorax. But the patient mainly will immediately exhibit:  1. Chest pain with SOB 2. Subcutaneous emphysema (pg. 952 Potter) 3. increasing levels of agitation 4.  decreased  or absent unilateral breath sounds (pg. 989 Osborn) They may also experience:  Respiratory distress Increased respiratory rate       Dyspnea Tachycardia       Cyanosis Hypotension       Deviation of trachea toward unaffected lung, tension or shifting of the heart and hyperresonance are late signs (tension pneumothorax) 3. Describe the pressure changes that occur intrapleurally with a pneumothorax. Atmospheric air enters the pleural cavity, resulting in the loss of negative pressure and collapse of the lung. Pneumothorax is caused by the rupture of  visceral pleura or the parietal pleura and chest wall. Under normal circumstances, intrapleural pressure is below atmospheric pressure (negative pressure).  As air separates the pleura, it destroys the negative pressure of the pleural space, disrupting the normal state of equilibrium. Because it is no longer held in  check by the recoil forces of the chest wall, the lung recoils and collapses toward the hilus. (pg. 987-989 Osborn) 4. What is the emergency management if a chest tube becomes disconnected? If the tube becomes disconnected from the drainage unit, instruct the patient to exhale as much as possible and cough. This maneuver rids the pleural space 
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Simulation Chest Tube-Level 2 - Lindsey Ellett NU 304 Chest...

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