Chest Tube Thoracostomy

[2bNurseTimTin]

What is the proper position for a patient with a Chest Tube Thoracostomy? tnx in advance.

[running_nurse]

usually these patients are supine with the head of bed 30-45 degrees.

but i have found that these patients tend to want to have their head of bed up as much as possible as it helps to alleviate some of their discomfort.

[Daytonite, BSN, RN]

here's online information about chest tubes:

• http://www.nursingcenter.com/prodev/ce_article.asp?tid=633945 - care of the patient with chest tubes
  
• http://www.icufaqs.org/chesttubes.doc

[buzkil]

Question-What if you have a patient d/c'd to sub-acute from hosp. Treated for massive plueral effusion in hosp. Chest tube d/c'd. 2days prior but site continues to drain very large amt, saturating occlusive drsg every 2-3 hrs. MD aware (pt.dx of lung ca) of amt of drainage. How would you best maintain the site?

[NRSKarenRN, BSN, RN]

Question-What if you have a patient d/c'd to sub-acute from hosp. Treated for massive plueral effusion in hosp. Chest tube d/c'd. 2days prior but site continues to drain very large amt, saturating occlusive drsg every 2-3 hrs. MD aware (pt.dx of lung ca) of amt of drainage. How would you best maintain the site?

Colostomy appliance.

Apply no sting skin prep surrounding area, stoma adhesive paste around CT exit site to form wall, apply ostomy appliance, can empty q shift and prn.

Some need red rubber catheter eye end inserted into site with wider end in bag for wicking action. Worked well for 2 of my patients.

PM if needed.

[buzkil]

Colostomy appliance.

Apply no sting skin prep surrounding area, stoma adhesive paste around CT exit site to form wall, applpy ostomy appliance, can empty q shift and prn.

Some need red rubber catheter eye end inserted into site with wider end in bag for wicking action. Worked well for 2 of my patients.

PM if needed.

Thank you NRSKaren. I appreciate your help.

[NRSKarenRN, BSN, RN]

Psssst: Empty ostomy bag when 1/3 to 1/2 full to prevent weight of bag pulling off of site.

Sometimes a much larger size that normally needed to compensate for heaviness of fluid ---helps with increased weight distribution (esp if pt putting out a cup of fluid in 8 hours) and prevents bag pulling off in my experience.