Policy Manual sample

MDT Home Health Care Agency, Inc. • Excess air and/or fluid accumulation in the pleural space. For example, chest tubes are often placed after cardiac surgery to drain blood associated with the surgery. • Need for pleurodesis: Pleurodesis is a procedure used to treat patients with recurrent pleural effusions or recurrent pneumothorax. This procedure involves administering a sclerosing agent into the pleural space which causes the visceral and parietal pleura to adhere to each other without the thin coating of fluid between them. Chemical pleurodesis is a painful procedure, and patients are often pre-medicated with a sedative and analgesics. A local anesthetic may be instilled into the pleural space, or an epidural catheter may be placed for anesthesia. • Chemotherapy administration: May be administered through a chest tube. Contraindications to Chest Tube Insertion There are no definite contraindications to a chest tube especially when a patient is experiencing respiratory distress. If multiple adhesions, giant blebs, or coagulopathies are present and the patient is relatively stable, the benefit of chest tube therapy can be carefully weighed against the higher risks of complications for these patients. In less clear-cut scenarios, it is often helpful to know the amount of lung collapse to better support a decision to insert a chest tube in higher risk patients. Risk Associated with Chest Tube Insertion Chest tube insertion can be performed with basic surgical skills. Risks can be minimized if attention is paid to careful technique and monitoring of the patient for complications. Any potential complications are often outweighed by life-threatening intrapleural collections. Risks associated with chest tubes include: • Bleeding at the site is a potential complication; however it is often minor and will likely resolve without intervention. • Risk of infection (e.g. empyema) and other associated complications increase the longer the chest tube remains inserted. • Subcutaneous emphysema, a collection of air under the skin, after chest tube placement. Small amounts of air near the chest tube insertion site will likely be absorbed, however, if this air moves to areas of the neck, chest, and face, it requires further attention if painful, though it is mostly a cosmetic issue. • Lung trauma and perforation of the diaphragm during insertion or removal is possible • Bronchopleural fistula, an abnormal connection between an air passage and the membrane that covers the lung, is also a reported complication. In the case of lung trauma or bronchopleural fistula, the chest tube must remain in place until the patient is fully healed. • Malposition of the chest tube is the most common of all complications, resulting in persistent air and fluid in the pleural space until the malposition is identified and resolved. The Basic Operating System A chest drainage unit is a device used to collect chest drainage (air, blood, effusions), and connects to the end of the chest tube. Most commonly, drainage devices use a single unit that has three chambers, based on the old three-bottle system. The three chambers each provide separate functions of: • Fluid collection • Water seal (which serves as a simple one-way valve) • Suction control Fluid Collection In a traditional water seal operating system, fluids drain from the patient directly into a large collection chamber via a 6-foot patient tube. As drainage fluids collect in this chamber, the nurse records the amount of fluid that collects on a specified schedule. Water Seal Home Health Agency Nursing Care & Procedures K-211