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Chest physiotherapy Percussion Cupped hands strike the chest repeatedly ? sound waves loosen secretions Vibration Vibrations using hands or vibratos to loosen secretions
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Chest physiotherapy Percussion& vibration X after meals X over: Chest tubes Sternum Spine Kidneys Spleen Breasts Caution with elderly
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Chest Drainage Tubes Continuous chest drainage Insertion of one or more chest tube by MD Into the pleural space Drain fluid or air
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Chest Drainage Tubes Indications Air in pleural space Pneumothorax Pleural effusion Penetrating chest injury Chest surgery
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Chest Drainage Tubes Upper, anterior chest (2nd & 4th intercostal space)? Remove air Lower lateral chest (8th or 9th intercostal space)? Remove fluid
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Chest Drainage Tubes MD inserts Nrs connects system and secures all connections Vaseline gauze and sterile occlusive dressing at insertion site to prevent leakage
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Chest Drainage Tubes 2 padded clamps at bedside Clamps only used if: Chest system accidentally disconnected Changing drainage system Trail period before removal
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Chest Drainage Tubes Tubes never clamped for more than few min ? Prevents air from escaping ? Buildup of air in pleural space ? Pneumothorax
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Chest Drainage Tubes 3-bottle system Water seal bottle Suction bottle Drainage bottle
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Chest Drainage Tubes Water seal When pt E ? Air trapped in the pleural space travels through chest tube to the water seal bottle ? Bubble up and out of the bottle
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Chest Drainage Tubes Water seal Water acts as a seal – allows air to escape, prevents air from getting back in Bubbles with E Normal Constant bubbling Abnormal – leak Check for leaks
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Chest Drainage Tubes Water Seal Water level fluctuates h I i E Tidaling Normal When lung is reinflated ? Tidaling stops If tidaling stops: Lung reinflated Tubing kinked Tubing occluded
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Chest Drainage Tubes Suction Bottle Suction sometimes used to speed up lung reinflation Amt of suction is dependent of the level of H2O in the bottle, not the amt of suction set on the machine
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Chest Drainage Tubes Suction Bottle Suction level order by MD -20cm Water Turn suction machine on enough to cause gentle bubbling Normal
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Chest Drainage Tubes Suction bottle Vigorous bubbling ? water evaporation ? change amt of suction Turn down suction No bubbling Kink in system Suction disconnected
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Chest Drainage Tubes Drainage bottle Collect fluid f
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Chest physiotherapy . Percussion& vibration. X after meals; X over: Chest tubes; Sternum; Spine
Chest physiotherapy . Percussion& vibration. X after meals; X over: Chest tubes; Sternum; Spine; Kidneys; Spleen; Breasts; Caution with elderly