Regular dressing changes done according to facility policy can help identify and prevent site infections. Tube Care: Chest Once chest tube is inserted: Determine if dry seal chest drain or water seal system is used. Drains that are placed very posteriorly may initially have a sufficient therapeutic… Regular dressing changes done according to facility policy can help identify and prevent site infections. If this happens, you may need to have another chest tube put in. She c/o pain in her chest, makes sense, a chest tube doesn't feel good! Goal Met. In people with cancer or infection, the effusion is often treated by using a chest tube to drain the fluid and treating its cause. Chest tubes are often inserted after lung surgery to remove fluids during healing. Healthcare providers in long-term care facilities encounter an increasing number of patients with indwelling medical devices. ... People who have HIV/AIDS may be at higher risk for fungal infection. Background . A chest tube is a hollow plastic tube which is inserted into the chest cavity to drain air or fluid. Assessment of risk factors: Assess the medical and general physical history to see if certain risk factors are present, such as if catheter is attached, if any open wounds, abrasions or tubes like drainage tubes or tracheostomy tubes are present. Proper Chest tube care is vital. Usually, bleeding is minor and resolves on its own, but bleeding into or around the lung may warrant surgical intervention. Identify how to prepare/assist with the insertion of a chest tube. Persons at risk for infection are those whose natural defense mechanisms are inadequate to protect them from the inevitable injuries and exposures that occur throughout the course of living. Infection risk increases with duration of tube placement. Auscultate chest sounds, perform a respiratory assessment including palpating for evidence of subcutaneous emphysema at and near the chest tube insertion site. Surgical drains are tubes placed near surgical incisions in the post-operative patient, to remove pus, blood or other fluid, preventing it from accumulating in the body. Breaks in the integument, the body’s first line of defense, and/or the mucous … Fluid in the chest may be blood (such as following surgery or trauma), pus (from an infection such as pneumonia), serous fluid, or contain cancer cells. 4. Research methodology: A case-control retrospective chart review was performed on 120 intensive care patients. If the patient has the risk factors, care is very important to safeguard the portal to stop infectious agent entry. The diagnosis may be made with a chest X-ray or chest CT scan, and a thoracentesis (lung tap) may be done to determine the type of bacteria causing the infection. Describe the risks/complications associated with chest tubes and chest drainage units (CDUs). 1–8 Chest infection carries an ≈3-fold increase in risk of death 1,9 and has the highest attributable mortality of all medical complications after stroke. Methods. 10 Chest infection is also associated with a greater likelihood of discharge to a nursing home 11 and increased length of hospital stay. One should assess the potential future need for additional therapy when deciding on the diameter of the tube. The type of drainage system inserted is based on the needs of patient, type of surgery, type of wound, amount of drainage expected and surgeon preference. Complications resulting from tube thoracostomy can occasionally be life threatening. If you are bed-bound and at risk of aspiration, keeping the head end of the bed raised at an angle of 30° may help. Wound infections related to the chest tube insertion sites. Infection. The nerves near the windpipe can be accidentally damaged, such as those controlling the voice box (larynx) or the tube that runs from the back of the throat to the stomach (oesophagus). It is generally used to drain pleural collections either as elective or emergency. When I listened to her heart, I could hear her rhythm was different, the extra gallop in the lube-dub. Abstract: The study examined the association between chest tube-related factors and the risk for developing healthcare-associated infections (HAI). Incorrect placement of a chest drain 1 Even when chest drain placement has been performed according to intrathoracic findings, “special” topographic localization is rarely required. Conclusion: The prehospital chest tube thoracostomy is a safe and lifesaving intervention, providing added value to prehospital trauma care when performed by a qualified physician. Chest tube insertion puts you at risk of several complications. RESULTS: The variable chest tube days was the only chest tube-related factor that was independently associated with HAI (OR = 5.78; p = 0.013). She has a-fib, and has a pace maker. If the fluid becomes infected, you may need to have it drained through a chest tube or removed with surgery. He or she will cover the area with a bandage that will stop air from getting into your chest. Accidental injury. The seriousness of pleural effusion depends on its primary cause, as well as how severely the breathing is affected. This rigid trocar is sufficiently sharp that it can be inserted into the incision site and forced into the pleural space with direct pressure and a twisting motion. Your chest tube may move out of place when you move or turn. Describe the monitoring of chest tubes and chest drainage systems. Lung abscess. Mechanical ventilation (OR = 4.88; p = 0.002) and outcome length of stay (OR = 0.72; p < or = 0.001) were also independently associated with HAI. NURSING CARE PLAN Nursing Diagnosis: Risk for impaired skin integrity related … If it is due to an infection, antibiotics will be given. The tube may damage organs that are close to your lungs. Skin disorders, such as burns or recurrent infections; Trauma or injury to the chest or esophagus, or indirect injury to the chest wall; Medical procedures - Heart Inflammation. Chest tubes can be purchased with or without a trocar, a sharp-tipped metal rod which extends through the distal end of the plastic tube. Aim. Objectives: The study examined the association between chest tube-related factors and the risk for developing healthcare-associated infections (HAI). Your healthcare provider will explain the risks and how likely they may be for you when you give consent for the procedure. Nursing interventions for this goal were effective and allowed the patient to achieve the long-term goal. Aim . Infections occur when an organism (e.g., bacterium, virus, fungus, or other parasite) invades a susceptible host. It should be noted that the risk of serious complications (bleeding and infection) is uncommon (usually less than 5% of cases). Her O2 was 99%, reps 20 and she did not c/o SOB. If water seal system is used: Check suction control chamber for correct amount of suction, as determined by water level, wall or table regulator, at correct setting. Cancer, such as lung cancer and lymphoma, or benign tumors, can cause pleural effusion. Gram-negative bacteria account for most nosocomial pneumonias in intubated patients, but Staphylococcus aureus may also play a role in what may be a polymicrobial infection. It is also important to be able to assess when the chest tube is ready to be discontinued. Risks of a chest tube: You may get an infection in the area where the tube was inserted. She has a stooped posture and she is weak, needing a walker to ambulate. Tube thoracostomy is widely used throughout the medical, surgical, and critical care specialities. Check fluid level in water-seal chamber; maintain at prescribed level. To present an update on the complications and management of complications of tube thoracostomy. A venous port system is composed of a port chamber attached to a central catheter, which is implanted into the central venous system. The position of the chest tube is related to the function that the chest tube performs. This may cause problems with speaking and swallowing. The catheter should be removed and samples obtained for microbial culture (Tasota et al, 1998). Pneumonia may cause fluid to build up in the thin space between layers of tissue that line the lungs and chest cavity (pleura). Infected hemithoraces related to TTs were found in 9% of those performed in the prehospital setting and 12% of ED-performed TTs (not significant). If you have swallowing difficulties, reduced sensitivity to irritants at the back of your throat, or some other condition that makes you prone to aspiration, feeding through a nasogastric tube may reduce the risk. Long-term tracheostomy tube may lead to irritation of the tracheal mucosa, further increasing the risk for infection. Note changes in drainage amount and character, which may indicate increased bleeding or new-onset infection. Other medical conditions - Pleural Disorders .