JASON MORGAN MS RN Pleural Effusion What is

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JASON MORGAN MS, RN

JASON MORGAN MS, RN

Pleural Effusion What is the underlying cause of the effusion? • Malignancy? • Liver

Pleural Effusion What is the underlying cause of the effusion? • Malignancy? • Liver failure? – • Post-op complication? – • Hepatic hydrothorax Common following cardiothoracic surgery Hepatic Hydrothorax – Pressure changes in the thoracic cavity with inspiration with acities fluid can cause a fluid shift into the pleural space. Treatment options • Thoracentesis – • Pleurodesis – • “tap their lung” Obliterates the pleural space; used for people for recurrent effusion We will see a chest tube or pigtail drain placed – – – The smaller tubes can be left in for chronic patients Patients can be discharged with a pigtail they can flush and care for at home. There can also be a shunt placed that drains into the peritoneum

Chest tube set-up • Suction – Not all chest tube set-ups with be to

Chest tube set-up • Suction – Not all chest tube set-ups with be to suction – Some are to water seal • In draining an effusion you can use gravity or suction… is gravity effective enough? • Clamping chest tubes – You clamp a chest tube set up that is for a pleural effusion to stop output • YOU NEVER CLAMP a chest tube that is being used to treat a pneumothorax • Why? – Clamp changes in thoracic pressure tension pnuemothorax lung collapses trachea deviates inferior vena cava compressed no return flow to heart cardiac arrest

Connect to suction tubing Don’t adjust Draw a line Date/time/initials tracks output JM 1/11

Connect to suction tubing Don’t adjust Draw a line Date/time/initials tracks output JM 1/11 1230 This will bubble if there is an air leak Never clamp when used to treat pneumothorax

Pigtail catheter

Pigtail catheter

Hemothorax Pneumothorax Can you see the collapsed boarder?

Hemothorax Pneumothorax Can you see the collapsed boarder?

Air leak � Check the patient Are they tachypnic/distress/RR/ 02 sat? Ask them take

Air leak � Check the patient Are they tachypnic/distress/RR/ 02 sat? Ask them take a deep breath, check for bubbles in chamber � Check the tubing Are all the connections secure? Is there damage to the tubing? � Check the dressing Is the dressing occlusive? Does it need reinforcement/Vaseline gauze � Call the team

Tube pulled �A catheter in placed into the pleural space to drain a collection

Tube pulled �A catheter in placed into the pleural space to drain a collection of fluid. You may gently flush the catheter, according to orders, and let drain to gravity. �If the tube is pulled out, it is in the pleural space, there should not be air escaping. Call them team. �If this is a chest tube for a pneumothorax place Vaseline gauze over the site with a dressing taped on 3 sides. Air can go out but not in… air in the chest cavity changes pressure and can lead to tension pneumothorax