Pleural Tapping
Pleural Tapping
on a stool and his arms on a pillow laid over the back of a chair. Sometimes the
patient leans over the bedside table.
Lying position:- The patient lies on a semirecumbent position on the side of the bed
most convenient to the doctor. He should lie with his affected side uppermost. A
small pillow is placed under the thorax so as to arch the vertebrae and to widen the
intercostal spaces. The arm of the affected side is held above head or forward with
the hand on opposite shoulder. The patient should not be exposed unnecessarily.
Nurse should remain with the patient.
Preparation of the patient:- The patient should be dressed in loose jacket over the
chest so as to expose the part easily during the procedure. He should be kept warm
throughout. Skin area is washed and cleaned well and painted with iodine and sterile
dressing applied over the part, and fix with binder or bandage.
Equipment
1) Screen for privacy
2) A tray containing:a)
b)
c)
d)
e)
a)
b)
c)
d)
e)
or it may be collected into the syringe and then put into the test tube.
Watch the patient's condition during the treatment; colour, pulse, breathing or
any difficulty, fainting or haemorrhage etc, When sufficient amount is taken the
needle is withdrawn, the puncture is sealed, dressings applied and fixed with
adhesive plaster' The patient rests for a prescribed period according to his condition.
Sputum should be watched for the presence of blood, after aspiration. Specimen
should be labelled and sent to the laboratory.
Record the treatments, amount, colour, type of fluid withdrawn, the time of
treatment, coughing any fainting gand any untoward symptoms accompanying or
following the procedure, or any benfical effects observed should be recorded. Note the
collection of specimen and the purpose of which they were sent to the laboratory.
Wash the things properly, sterilize and keep in proper places.
Water seal Chest Drainage
Water Seal Chest Drainage means that a column of water in a bottle seals off the
atmospheric air preventing from entering the chest drainage tube and thereby in the
pleural space. It is a closed drainage system by which the air and fluid in the pleural
space is escaped through the drainage tube during exhalation and prevent their
return flow to the pleural space during inhalation. It acts only on one way flow from
into out and not from out to in, provided the apparatus is in proper working
condition.
The normal breathing mechanism operates in the principle of negative pressure
(the pressure in the chest cavity is lower than the pressure of the outside air, causing
air to rush into the lungs). Whenever the chest is opened, for any cause, there is a
loss of negative pressure which can result in the collapse of the lungs. The collection
of air, fluid, or other substance in the chest can complicate cardiopulmonary function
and even cause collapse or the fung, because these substances take up space. Three
types of pathologic substance collect in the pleural space.
1) Solids (fibrin or clotted blood)
2) Liquids (serous fluids, blood, pus, chyle)
3) Gas (air from the lung, tracheobronchial tree, or Oesophagus)
Surgical incision of the chest wall almost always causes some degree of pneumothorax. Air and fluids collect in the intrapleural space, restricting lung expansion
and reducing air exchange. It is necessary to restore pleural negative pressure and
prevent this from happening. Therefore, during or immediately after thorasic surgery,
chest catheters are positioned strategically in the pleural space, sutured to the skin
and connected to some type of drainage apparatus in order to remove the residual air
and drainage fluid from the pleural or mediastinal space. This assists in the reexpansion of remaining lung tissue.
A chest drainage system must be capable of removing whatever collects in the
pleural space so that a normal pleural space and normal cardiopulmonary function
may be restored and maintained. There are many types of commercial chest drainage
systems in use and most of which work on water seal principle. The chest catheter is
attached to a bottle, using a one-way valve principle. Water act as a seal and permits
air and fluid to drain from the chest, but air cannot re enter the submerged tip, of the
tube. The care of the patient with water-seal chest drainage* is discussed below.
5
The amount of
suction is determined by the depth to which the tip of the venting glass tube is
submerged. (For example, submersion to 10 cm below the surface of the water will
equal 10 cm of water suction applied to the patient.)
In the three-bottle system (as in the other two) drainage depends on gravity or
the amount of suction applied. The amount of suction in the system is controlled by
the manometer bottle. The mechanical suction motor or wall suction creates and
maintains a negative pressure through out the entire closed drainage system.
The manometer bottle regulates the amount of vacuum in the system. This bottle
contains three tubes:
1)
2)
3)
A short tube above the water level comes from the water-seal bottle.
Another short tube leads to the vacuum or suction motor or wall suction.
The third tube is a long tube (stand pipe) which extends below the water-level in
the bottle and which is open to the atmosphere outside the bottle. This is the
tube that regulates the amount of vacuum in the system. This is regulated by
the depth to which this tube is submerged-the usual depth is 20 cm (7.6
inches)
When the vacuum in the system becomes greater than the depth to which the
tube is submerged, outside air is sucked into the system. This result in constant
bubbling in the manometer (or pressure-regulator) bottle, which indicates that the
systems is functioning properly.
Management of the patient with water seal chest drainage
Procedure
7
Sl.No
1)
Nursing Action
Rationale Amplification
Attach the drainage tube from Water-seal drainage provides for
the pleural space to the tubing the escape of air and fluid into a
that leads to a long tube with drainage bottle. The water acts as
end submerged in sterile normal a seal and keeps the air from
saline.
2)
space.
Tape the places where the tubing Taping the connecting points of
is connected if needed some the tubing will make certain that
connectors hold without taping.
(a) The
tube
should
be
the
short
glass
tape
the
on
the
outside
of
show
the
drainage
bottle.
Mark
hourly/daily
increments
(date
Drainage
usually
with rubber bands and safety the drainage tubing can produce
pin so that flow by gravity will back pressure, and may thus
occur. The tubing should not possibly force drainage back into
loop
or
interfere
with
the the
pleural
space
or
inpede
promote
good body alignment. When the drainage and the body should be
patient is in the lateral position kept in good alignment to prevent
place a rolled towel under the postural
deformities
and
breathing
and
promotes
and breathing.
Pool the arm and shoulder of the Exercise helps to avoid ankylosis
affected side through range of of the shoulder and assists in
motion
exercises
several
will
expansion
faciliate
of
the
prompt
lung
and
minimise complication
Make sure there is fluctuation Fluctuation of the water level in
(tidaling) of the fluid level in the the tube shows that there is
long glass tube
pleural
drainage
cavity
bottle,
and
provides
the
a
0)
1)
of
fluid
in
the
is obstructed by
is
or
not
wall
working
properly.
Watch for leaks of air in the
pleural
space
tension
pneumothorax.
seal bottle.
a) Clamp
can
result
If
in
the
tubing
patient's pneumothorax.
physician.
b) Report excessive bubbling
in
the
water-
seal
chamber immediately.
c) Milking of chest tube in
patients
with
air
leak
Many
subcutaneous, emphysema, or
symptoms of haemorrhage.
severe
clincal
chest
conditions
pain,
may
pulmonary
2)
3)
4)
5)
Surgical
intervention
necessary.
Encourage the patient to breath Deep breathing
deeply and cough at frequent help
to
raise
and
the
may
be
coughing
intrapleural
medication is of
indicated.
the
pleural
secretion
accumulation,
in
space
removes
from
and
the
the
tracheob-
is
prevented.
If any part of the apparatus is
atmospheric
pleural
pressure
space
and
in
the
resultant
the
patient
transported
to
has
another
negative
intrapleural
pressure.
be The drainage apparatus must be
to
stretcher.
Hemostats
is
transported.
When assisting the surgeon in
a) Instruct
tm
patient
to
perform
the
valsalva's
(forcible
glottis,
maneuver
holding
one's
breath.
b) Chest tube is clamped and
quickly removed.
c) Simultaneously a
withdrawn
and
prevention
of
infection.
small
air
tight
with
4"
thoroughly
gauze
and
covered
and
head is down. The upper lobebronchi empty more effectively when the head is up.
Frequently the patient is placed in five positions.
1 Position for drainage of each lobe.
2 Head down, position.
3 Prone position.
4 Right and left lateral position.
5 Sitting upright position.
Postural drainage is usually done four times daily, before meals and at bed
time. If prescribed bronchodilator aerosol medtcations may be inhaled before postural drainage to reduce bronchospasm, decrease thickness of mucus and sputum
and combat odema of the bronchial walls. The patient should be made as comfortable as possible in each position and an emesis basin or sputum cup and paper
tissue should be available. The patient is instructed to remain 5-10 minutes in each
position and to breath slowly through his nose and blow out through his mouth
while assuming the posture. If he cannot tolerate the position, he should be helped
13
Following the procedure, the amount, colour, viscosity, and character of the
ejceted sputum is noted; the patient's colour and pulse are evaluated in the first few
times the exercise are performed. It may be necessary to administer oxygen during
postural drainage.
After postural drainage, the patient is made to brush his teeth, or given oral
care before resting in bed.
BIBLIOGRAPHY
14
General nursing & Midwifery Course. 1st Edition, Jaypee Brothers, Medical
Publishers (p) Ltd., New Delhi.p:192-198.
2) Nancy Sr., 2002, Principles & Practice of Nursing & Nursing arts procedures,
5th edition published & Printed by N.R. Publishers, House, Indore.p:401-412.
3) LC Gupta US, Sahu, Priya Gupta, 2007 Practical Nursing Procedure. 3 rd
Edition, Printed at Para Offset Pvt. Ltd. New Delhi; p: 422-427.
4) Sagunthala Sharma Birpuri 1997 Principles and Practice of Nursing 1 st
edition Printed at Lordson Publishers (P) ltd., New Delhi. p.156-160.
5) Brunner & Siddarths, 2001, Text book of Medical- surgical Nursing- 12 th
edition, volume2, published by Wolters Kluwer (India) pvt. Ltd New Delhi, Page
No: 741-748
6) Lewis, collier, Heitkemper, 1996 Medicalsurgical Nursing, 4 th Edition, Mosby
year book- Inc USA, Page no: 443-448
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