JASON MORGAN MS RN Pleural Effusion What is
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JASON MORGAN MS, RN
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 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 1230 This will bubble if there is an air leak Never clamp when used to treat pneumothorax
Pigtail catheter
Hemothorax Pneumothorax Can you see the collapsed boarder?
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 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