Lecture Notes: Pleural Disorders and Chest Tubes

Overview

• Discussion on pleural disorders, chest tubes, and tension pneumothorax.
• Includes a review quiz at the end to test understanding.

Anatomy and Physiology Review

• Pleura surround and protect each lung with two layers.
• Pleural Cavity: Space between the two layers; normally, should not accumulate air, blood, or fluid.
• Conditions:
  • Pneumothorax: Accumulation of air.
  • Hemothorax: Accumulation of blood.
  • Pleural Effusion: Accumulation of fluid.

Signs and Symptoms of Pleural Disorders

• Respiratory distress.
• Reduced or absent breath sounds on the affected side.
• Percussion Indicators:
  • Hyperresonance: Pneumothorax.
  • Dullness: Hemothorax or pleural effusion.

Diagnosis and Treatment

• Diagnosis: Chest X-ray.
• Treatment:
  • Chest tube insertion for drainage.
  • Medications: Benzodiazepines for anxiety, opioid analgesics for pain.

Chest Tubes

• Purpose: Drain air, blood, or fluid from pleural space.

Three Chambers of a Chest Tube

1. Drainage Collection Chamber:
   • Monitor and chart drainage amount and color.
   • Report excessive drainage (>100 ml/hour) to provider.
2. Water Seal Chamber:
   • Maintain sterile fluid at 2 cm line; check for tidaling.
   • Lack of tidaling could indicate lung re-expansion or obstruction.
   • Continuous bubbling indicates an air leak.
3. Suction Control Chamber:
   • Continuous bubbling is expected.

Nursing Care and Best Practices

• Confirm chest tube position with a chest X-ray post-insertion.
• Use occlusive dressing on insertion site; monitor for subcutaneous emphysema and infection.
• Subcutaneous Emphysema: Feels like "Rice Krispies" under the skin.
• Only clamp the chest tube if ordered; never strip tubing.
• Encourage deep breathing, coughing, and use of incentive spirometer.
• Keep padded clamps, sterile water, and sterile gauze at bedside.
• In case of disconnection, place tube in sterile water to maintain seal.
• If chest tube is removed, cover site with dry sterile gauze and notify provider.
• Monitor for complications like tension pneumothorax.

Tension Pneumothorax

• Cause: Air trapped under positive pressure in pleural cavity.
• Risk Factors: Chest tube occlusion, mechanical ventilation, fractured ribs.
• Symptoms:
  • Tracheal deviation towards unaffected side.
  • Absent breath sounds on affected side, thorax asymmetry.
  • Respiratory distress, tachycardia, tachypnea, neck vein distention, pallor, anxiety.
• Diagnosis: Chest X-ray, ABGs.
• Treatment: Immediate needle decompression followed by chest tube insertion.

Review Quiz

1. Percussion Sound in Pneumothorax: Hyperresonance.
2. Chamber with Continuous Bubbling: Suction control chamber.
3. Tracheal Deviation Disorder: Tension pneumothorax.

Conclusion

• Review flashcards for key concepts.
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