Nursing - Tubes And Tube Care

Front 1

Chest tubes:
what is it?
why/when is it used?

Back 1

a catheter inserted, by a physician, into the thorax to drain fluid or air, thus promoting lung expansion
why?
post chest surgery
trauma to the chest
pneumo- or hemo- thorax

Front 2

Pneumothorax?
inserted where?

Back 2

a collection of air in the pleural space causing a loss of negative pressure and lung collapse.
S/S:
-pain (sharp)
-dyspnea

Causes:
-chest trauma
-rupture of emphysematous bleb
-invasive procedure (subclavian IV line insertion)

Inserted:
-2nd intercostal space

Front 3

Hemothorax?
inserted where?

Back 3

accumulation of blood and fluid in the pleural cavity causing counterpressure and prevents lung from full expansion
S/S:
-pain
-dyspnea
-shock (if large amounts of blood loss)

Causes:
-trauma to chest
-rupture of small blood vessels from inflammatory process (infection - pneumonia, TB)

Inserted:
-4th or 5th intercostal space

Front 4

Risk associated with pneumonthorax?

Back 4

Tension pneumonthorax: air or fluid cannot escape-
medinstinal shift: movement of heart, trachea and esophagus

Front 5

Drainage System:
3 bottle system

Back 5

prevents air and fluid from returning to the pleural space and restoring negative pressure.
bottle 1: collecting fluid
bottle 2: straw delivers air into water, causing bubbling - air can only move into open straw at other end
bottle 3: water level (approx 20cm) allows for suctioning (with gentle bubbling) of air out of bottle

Front 6

Drainage System:
traditional chest draining box
wet seal + wet suction
wet seal + dry suction

Back 6

same principles but converted to box form
Tidal - movement of water level up on inspiration and to normal on expiration
Water seal - continuous bubbling indicated a leak
Suction chamber - continuous gentle bubbling should be present

Front 7

Assessment

Back 7

patient:
-pulmonary status- rate, ease, SpO2, breath sounds, cyanosis
-pain

system:
site to source- insertion site, dressing, tubing (no kinks, loops, clots), drainage box (upright, below insertion level

Front 8

Dressing care

Back 8

sterile technique
cleanse with NS around tube
assess skin around area

apply gelnet - vaseline infused gauze to seal air leaks
apply precut tube gauze
tape abdominal dressing over top

Front 9

Tube loss

Back 9

place hand over hole
cover during inspiration
uncover during expiration

gauze taped on 3 sides only: provides a seal on inspiration

Front 10

Suctioning
what is it?
why is it needed?
S/S:

Back 10

removal of secretions via suction, using a round tiped catheter that has holes on the distal end

if a person is unable to clear respiratory secretions on their own - suctioning is done with need, not with routine
S/S:
-lowered SpO2
-pooling of secretions: gurgling, drooling, adventitious sounds, vomit, coughing
-restlessness

Front 11

Oropharyngeal and Nasopharyngeal

Back 11

Oropharyngeal - mouth after soft palate, above hyoid bone and tonsils
Nasopharyngeal - behind the nose to soft palate

patient is able to cough but cannot swallow or spit the secretions

Front 12

Orotracheal and Nasotracheal

Back 12

orotracheal
nasotracheal

patient has no artifical airway but is not able to manage secretions through coughing

catheter is placed through nose (prefered, less gag reflex stimulation) or mouth towards trachea

must be done quickly (15 secs) with rest periods in between (using O2 if needed)

Front 13

Tracheal

Back 13

is done through artificial airway (endotracheal tube or tracheostomy tube)
catheter < 1/2 inner diameter of tube
1. insert catheter without suction
2. create suction while slowly removing catheter
3. rotate for optimal suctioning

open: one time use, sterile catheter
close: multiple use, covered catheter

Front 14

Risks of suctioning

Back 14

too frequent:
hypoxemia
hypotension
arrhythmias
trauma to lining of airways

Front 15

Oral airway

Back 15

-prevents obstruction of the trachea by the tongue
-from teeth to oropharynx, maintaining normal tongue position
-measure from corner of mouth to angle of jaw below ear
-nurses may insert

Front 16

Endotracheal airway

Back 16

short term use (removed in approx. 14 days)

uses:
-administer mechanical ventilation
-relieve upper airway obstruction
-protect against aspiration
-clear secretions

increased risk for infection - sterile technique is used when inserting and maintaining

Front 17

Tracheostomy

Back 17

long term need
cut into trachea, short appliance inserted

Front 18

Parts of the tracheostomy tube
(5)

Back 18

1. flamge
2. outer cannula
3. inner cannula
4. obturator
5. plug

Front 19

Cleaning tracheostomy tube
Steps

Back 19

1. assess need for cleaning
2. gather supplies
3. suction trachea
4. remove dressing, discard
5. prep sterile tracheostomy kit: trays, solutions (normal saline + hydrogen peroxide), dressings, brushes
6. apply sterile glove to dominant hand, apply clean glove to non-dominant
7. remove O2
8. remove inner cannula with non dominant hand, place in hydrogen peroxide
9. clean inner cannula with brush
10. rinse with NS
11. replace and lock, reapply O2
12. clean exposed outer cannula surfaces
13. clean stoma under face plate (using cotton swabs) in circular motions
14. secure tracheostomy with new tie before removing the old
15. apply tracheostomy dressing
16. position patient
17. clean up