Policy Manual sample

MDT Home Health Care Agency, Inc. CARE OF THE PATIENT WITH A CHEST TUBE (RN/LPN) Maintenance and Care of Patient with a Pleur-Evac POLICY The purpose of this policy is to allow our nurses to access it as a guide in the care, management and troubleshooting of chest tubes and the collection system. Skill Level: Registered Nurses LPN’s are responsible for: Ensuring the position of the Pleur-Evac is below the level of the insertion of the chest tube. Notifying the RN of any abnormal vital signs or respiratory distress. Definitions Pneumothorax: A collection of air in the pleural space. Note that pneumothorax is the most common serious pleural complication in the Intensive Care Unit & the most common reason for inserting a chest tube. Tension pneumothorax: Occurs when air accumulates in the pleura space to the point of causing a mediastinal shift pushing the heart, great vessels, trachea, and lungs toward the unaffected side of the thoracic cavity. Hemothorax: A collection of blood in the pleural cavity. Hemopneumothorax: An accumulation of both air and blood in the pleural cavity. Pleural effusion: Is excessive fluid in the pleura cavity. Chylothorax: Is the accumulation of lymphatic fluid in the pleural space. Empyema: Is a collection of purulent material from an infection like pneumonia. Use of Chest Tubes There are many clinical conditions that may necessitate the use of chest tubes. When there is an accumulation of positive pressure in the chest cavity (where it should normally be negative pressure between pleurae), a patient will require chest drainage. Chest tubes may be inserted to drain body fluids or to facilitate the re-expansion of a lung. No matter what the reason or underlying cause, chest tubes help to resolve the problems associated with large volumes of air or fluid that have collected in the pleural space. When air or fluid enters the pleural space, the lung cannot expand properly. In some cases, chest tubes can also be used for certain therapy-related patient management as well. The use of chest tubes is not completely fail safe; complications can arise. Indications for Chest Tubes There are various reasons for excess air and/or fluid in the pleural space. Specific common indications for chest tubes include: • Pneumothorax (open and closed). • Tension pneumothorax. • Hemothorax. • Hemopneumothorax. • Pleural effusions. • Chylothorax (a type of pleural effusion that results from lymphatic fluid (chyle) accumulating in the pleural cavity). • Penetrating chest trauma. • Pleural empyema (collection of purulent material in the lungs). Other indications include: Home Health Agency Nursing Care & Procedures K-210