Chest intubation indications,precautions and management

Dr.KAMRAN YOUSAF
FCPS,MRCS
GEN SURGEON,MEEQAT GEN HOSPITAL
MADINA MUNAWWARA

1. CHEST INTUBATION INDICATIONS,PRECAUTIONS AND MANAGEMENT KAMRAN YOUSAF FCPS,MRCS GEN SURGEON,MEEQAT GEN HOSPITAL MADINA MUNAWWARA

2. DEFINITION CHEST/INTERCOSTAL INTUBATION OR TUBE THORACOSTOMY IS A LIFE SAVING PROCEDURE WHEREBY A PLASTIC TUBE IS INSERTED INTO THE PLEURAL CAVITY TO DRAIN FLUID,AIR OR BOTH IT CAN BE PERFORMED AT THE BEDSIDE EVERY SURGICAL/ER RESIDENT IS EXPECTED TO PERFORM IT AND SHOULD BE TRAINED SO

3. INDICATIONS TRAUMATIC AND NON TRAUMATIC HAEMOTHORAX PNEUMOTHORAX PYOTHORAX/EMPYEMA THORAX CHYLOTHORAX PST OPERATIVE THORACOTOMY

4. HYDROTHORAX

5. MECHANISM

6. CONTRA-INDICATIONS LUNG ADHERENT TO THE CHEST WALL COAGULOPATHY

7. PRECAUTIONS CORRECT PROCEDURE,CORRECT PATIENT AND CORRECT SIDE WRITTEN INFORMED COSENT PREPARE THE EQUIPMENT STERILE ENVIRONMENT DISPLAY THE X-RAYS IN THE ILLUMINATOR BOX POSITION OF THE PATIENT

8. TRIANGLE OF SAFETY

9. TRIANGLE OF SAFETY 4 TH /5 TH INTERCOSTAL SPACE LATERAL BORDER OF PEC MAJ ANT BORDER OF LAT DOR HORIZONTAL LINE FROM NIPPLE APEX JUST BELOW AXILLA

10. EQUIPMENT/INSTRUMENT STERILE GLOVES/GOWN/DRAPES/BETADINE CHEST TUBE AND THE DRAINAGE SYSTEM SYRINGE LOCAL ANAESTHESIA SCALPEL ARTERY FORCEPS THUMB FORCEPS SCISSORS NEEDLE HOLDER SUTURE MATERIALS GAUZE/DRESSING MATERIALS

11. INSTRUMENTS

12. CHEST TUBES TYPES/SIZES

13. CHEST TUBES THREE TYPES THORACOTOMY CHEST TUBE TROCAR CHEST TUBE MALECOT CATHETER SIZE 24-32 F FOR MOST ADULTS 36-40 F FOR HEAVILY BUILT

14. THE DRAINAGE SYSTEMS

15. THE PROCEDURE

16. DURING THE PROCEDURE OBSERVE PATIET’S BREATHING PATTERN OXYGEN SATURATION VITAL SIGNS ANXIETY ANALGESIA BEFORE THE PROCEDURE READY UNDERWATERSEAL

17. POST PROCEDURE CARE MONITOR VITALS ,,,30 MIN/2 H,THEN HOURLY FOR 4 HOURS MONITOR HIS RESPIRATION RATE,RYTHEM AD PATTERN OF BREATHING MONITOR OXYGEN SATURATION POST INTUBATION CXR MONITOR THE TUBES/DRESSING PLACEA PILLOW BETWEEN THE PATIENT AND THE TUBE AVOID COILS OF TUBE, NEVER TO RISE IT ABOVE THE CHEST LEVEL

18. CONTINUD IF BLOCKED, ENCOURAGE COUGHING AND MILK THE TUBE NO UNNECESSARY CLAMPING EXCEPT DURING TRANSFER/CHANGE DRAIN OUTPUT RCORD CHANGE BOTTLE EVERY 24/48 HOURS OR WHEN FULL ENCOURAGE AMBULATION AND BREATHING EXCERCISES AND POSITIONAL CHANGES GOOD ANALGESIA AND HYGIENE

19. COMPLICATIONS INJURY TO LUNGS INJURY TO LIVER/SPLEEN WRONG PLACEMENT NEUROVASCULAR BUNDLE INFECTION

20. TUBE REMOVAL WHEN ITS NO LONGER REQUIRD THE INDICATION DOES’NT EXIST FLUID/AIR HAVE BEED DRAINED,LUNG HAS EXPANDED,BREATHING IS NORMAL,SATURATION IS GOOD AND THE CHEST X-RAY IS NORMAL CLAMP FOR 2 HOURS,NO ISSUES REMOVE

21. WHAT TO DO IF,,, DURING THE PROCEDURE BLEEDING,SATURATION DROP,WRONG INTUBATION POST PROCEDURE TUBE DISLODGEMENT,BLOCKAGE ETC

22. NURSING PERSPECTIVE PRE-OP ,,,ENSURE,CONSENT,RIGHT,RIGHT AND RIGHT ENSURE AEPTIC ENVIRONMENT,EQUIPMENT ENSURE IV LINE/CXR IN ILUMINATOR DURING PROCEDURE ,MONITORING, READY UNDERWATERSEAL,IV FLUIDS,O2 SUPPLY,SPARE INSTRUMENTS,TUBES POST PROCEDURE ,MONITOR THE DRESSING,TUBES,DRAIN,FLUID LEVEL,BUBBLING,VITALS,O2 SAT,CXR

23. SUMMARIZE LIFE SAVING PROCEDURE AIR,FLUID,BOTH ASEPTIC ENVIRONENT,PROPER EQUIPMENT,RIGHT,RIGHT,RIGHT ANTICIPATE AND PREPARE FOR UNEXPECTED COMPLICATIONS MONITOR DURING AND AFTER THE PROCEDURE REMOVE WHEN NOT NEEDED

24. FLORENCE NIGHTINGALE FOUNDER OF MODERN NURSING