Concepts On Oxygenation

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Concepts on

Oxygenation

Chest tubes &


Water seal
Drainage
Indications for Chest tube
drainage
 To evacuate air or fluid from pleural space
 Pneumothorax > 20 %
 Hemothorax > 500cc
 Pneumohemothorax
 Pleural Effusion
 Fluid collections
 Mechanically ventilated patients with any size
pneumothorax or hemothorax
Indications for Chest tube
Drainage

 Respiratory distress or ventilator


dependence that does not permit
thoracentesis
 Monitor ongoing air leak or blood loss
Contraindications

 Coagulopathy or platelet dysfunction


warrants caution
 Known or suspected mesothelioma
 Pure tuberculosis effusion
Types & Purposes of Chest
tubes
1. Pleural Tubes
> the insertion
of pleural tube permits
removal of the air or
bloody fluid & allows
for reexpansion of the
lung and restoration of
the normal negative
pressure in the pleural
space .
Types & Purposes of Chest
Tubes cont’d.
2. Mediastinal tubes
> are placed to en -
sure that fluid does
not accumulate &
put pressure on the
heart but instead
drains to facilitate
healing
Chest Tube Size
 French sizing refers to circumference in
millimeters
 Pure Pneumothorax : French 20 – 24
 Fluid : French 28 tubes are recommended
 French 32 or larger tubes tend to cause too
much discomfort unless a rib resection is
performed
Principles of Chest
Drainage
Principles Involved
 Gravity
 positive pressure
 Suction
 Water – seal principle
TYPES OF CHEST
TUBE DRAINAGE
SYSTEM
1. SINGLE – BOTTLE 2. TWO – BOTTLE
WATER SEAL WATER SEAL
SYSTEM SYSTEM
 The end of the  consists of the same water –
drainage tube from the seal chamber , plus a fluid –
patient’s chest is covered by a collection bottle
layer of water , which permits  Drainage is similar to that of
drainage of air & fluid from the a single unit , except that
pleural space , but does not when pleural fluid drains ,
allow air to move back into the the underwater – seal system
chest . is not affected by the volume
 Functionally , drainage of the drainage
depends on gravity , on the  Effective drainage depends
mechanism of resopiration , & if on gravity or on the amount
desired , on suction by addition of suction added to the
of controlled vacuum system
3. THREE- BOTTLE 4. PLEUR – EVAC WATER
WATER SEAL SEAL SYSTEM
SYSTEM
 There’s an addition of a 3rd
bottle to control the amount of  Is a three- chambered system
suction applied that utilizes the same basic
 The amount of suction is principles as the classic
determined by the depth to three-bottle system
which the tip of the venting glass
tube is submerged in the water
 Drainage depends on the gravity
or the amount of suction applied
, which is controlled by the
manometer
bottle
 The mechanical suction motor /
wall suction creates & maintains
a negative pressure throughout
the entire closed drainage
system

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