Transcript Indications & Management of ICC’s & UWSD’S

Indications & Management of
ICC’s & UWSD’S
Nardine Johnson CDN
SAPU
Surgical assessment & Planning Unit
March 2013
Learning Objectives
• Revise the Anatomy & Physiology of the
lungs
• Understand the Indications for insertion of an
Intercostal Catheter
• Demonstrate correct setup of UWSD
• Understand the Nursing management of an
ICC & UWSD
Anatomy & Physiology
• Identification of key anatomy is vital when caring for
an ICC;
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Larynx
Trachea
R) & L) main Bronchus
Carina
Secondary & Tertiary Bronchus
Alveoli
Visceral pleura & Parietal pleura
Diaphragm
Ribs & Intercostal spaces
Respiratory Pressures
• Respiratory pressures- described relative to atmospheric
pressure.
• Atmospheric pressure is the pressure exerted by the air
surrounding the body.
• Intrapulmonary pressure, the pressure rises & falls with the
respiratory cycle, always equalises with atmospheric.
Physiology
• On Inspiration, pressure in pleural space becomes
more negative(from –3cmH20 to –6H20). Pressure
allows air to enter the lungs.
• On Expiration, pressure in pleural space becomes
less negative. Pressure equalisation causes air to
exit the lungs.
Indications for an Intercostal Catheter
• The accumulation of air, fluid or blood into the pleural
space caused by;
Injury- Chest trauma, i.e. Motor vehicle accident
Medical Problems- spontaneous pneumothorax,
bleb rupture, Cancer related.
Surgical- Thoracotomy, VAT.
Indications
• Pneumothorax- a collection of gas or air in the
pleural space causing the lung to collapse.
• Pleural effusion- a buildup of fluid between the
layers of tissue that line the lungs and chest cavity
• Haemo pneumothoraxAn accumulation of blood & air in the pleural cavity.
• Tension PneumothoraxA condition of air in the intrapleural space of the
thorax caused by rupture of the chest wall & which
the air is retained in the pleural space with no
escape.
• Signs of a Tension pneumothorax;
mediastinal shift, overexpanded chest, shallow gasping
respiration, tracheal deviation & changes in arterial
pulse.
Tension Pneumothorax
Further Indications
• Hemothorax- An
accumulation of blood &
fluid in the pleural
cavity, between the
visceral & parietal
pleura.
Open Pneumothoraxopen cavity directly thru
to pleural cavity,
“sucking” wound of the
chest.
Atrium Dry suction Chest drain
• Atrium Dry Suction
Chest Drain
• used for evacuation of
air/& or fluid from
chest cavity, reestablish lung
expansion.
Setup of Atrium
1. Fill water seal to 2cm
line- twist top off bottle
& insert tip into suction
port, squeeze contents
into water seal until fluid
reaches 2cm fill line.
2. Connect patient Tube
to patient
3. Connect Suction to
chest drain
4. Adjust dry suction
regulator, preset to 20cmH20, can be
adjusted from 10cmH20 to -40cmH20.
5. Turn suction source
on
Instructions for use
• Suction bellows, will
expand to the ▲mark or
beyond when suction is
connected & operating.
• Water seal, must be
filled to 2cm line for
system operation & air
leak detection, once
filled seal becomes
tinted blue.
Air leak monitor, air leak
bubbling can range
from 1(low) to 5(high),
can monitor pattern
• Sampling drainage,
needle-less Luer port
on patient tube
connector.
Nursing Management
• ObservationsBubble/Air leak, observed in the water seal
chamber, indicates air in the pleural space,
or a system leak. To check disconnect from
suction, instruct pt to take a deep breath &
cough out, observe if bubbling is continuous,
intermittent or absent
NOTEThe patient must have 2 Howard kelly clamps
with them at all times
Bubbling occurs as a
result of the air
escaping from the
pleural space & then
being trapped by the
water seal to prevent
re-entry back into the
pleural space.
Swing/Oscillation, measured in the water seal
chamber. Fluctuations in the fluid level swing) are
caused by the changes in intrapleural pressure. To
check disconnect from suction, deep breath in &
out.
No swing may be caused by obstruction of the tube or
full expansion of the lung occluding eyelets in the
tube.
• Drainage, is usually blood, hemoserous or serous.
To check observe level of fluid, type, calculate
hourly drainage, ensure tubing is not kinked or
looped, >100ml/hr= heavy drainage.
Dressing
• Occlusive, clear
dressing- It is better if it
is clear so we can see
any ooze & what colour
it is. Should be attended
daily.
• Drain sponge,
Tegaderm, leukoplast at
connections & to secure
to patients skin.
Heimlich Valve
Thankyou!!!!