a pulmonary puzzler

[Agnus]

This is just too weird.

This is a real situation that I encountered, see if you can figure it out. A patient had emypema. He has had a chest tube in for some time. He had gone home with the tube and is now back.

All this time the tube is open to air At home his wife flushed it with N/S and now we are flushing the cavity with N/S and all the time the patient is conversing with up and experiencing no pain.

Why has his lung not collasped?

Good luck!

I would love it if someone could figure it out. I know the answer but the doc had to tell me. Give it a try and I'll share the answer.

All the while I'm irrigating I hear my teacher's voice Yelling at me that you NEVER put anything in a chest tube and you NEVER let a chest tube be open to atmsopheric pressure.

[moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS]

I can see if it is a heimlich valve that it is okay to leave it open to air. Which is just generally a one way valve, but to put water into a line that directly enters the chest. The patient's wife must have misunderstood something somewhere in the process on how to care for chest tubes.

[Agnus]

Nope, nice try. I would have not thought of the valve. There was no mistake about irrigating it.

Hint. it was not due to anything artificial (i.e. out side of the pt's own physiology) that caused this. However there was an alteration in physiology (that likely resulted from the original condition)

[kids]

Let me guess...

The empyema created an adheasion where the lung meets the plura that keeps the lung from collapsing.

[hoolahan, ASN, RN]

That would be my guess too. Not sure if NS is a sclerosing agent, (is that what they call it.) I vaguely recall sometimes hearing of talc, or strong antibiotics being used to create a pocket this way so that the pleura would fuse and prevent air leaks. Then, sometimes the pocket was opened to air so it could be more easily irrigated.

[kids]

hoolahan...

until Angus tells us any different lets just go with this theory

...I am guessing it was sclerosed on the previous admit. I've done abx instillation where we put the abx in and clamped it...then opened it to drain a period of time later.

Boy I sure miss doing weird stuff!

-nancy

[Agnus]

Ok, here's what the doc told us. There were adhesions which anchored the lungs to the wall of the plureal cavity keeping them in their normal expanded position.

This was the strangest thing I have come across and had to share it. My instructors from school and co workers and other nurses with whom I shared this were completely mistified (as was I)

You are good. :)

[kids]

Yeah! we guessed it.

Home Care Nurses ROCK!

Thanks for making me think Angus.

-nancy

[Agnus]

None of us had ever seen anthing like it. Guess that what happens in a small town in an underpopulated state. Anything a little unusual is a big deal here.

Thanks for your answers, I learned from them.

When I was still working at that hospital, I heard another story.

I don't recall for sure if it had happened at that particular hospital, ( think it did). A patient had received so much food coloring in tube feeding that he turned green including the sclera of his eyes. The dietition involved wrote it up in her professional journal.

[NurseDennie, BSN, RN]

Okay, I'd guessed adhesions, as well.... BUT where *exactly* is the CT going and why are they flushing with NS??

Love

Dennie

[Agnus]

This is really past tense and happened at an other hospital. So I don't have contact with the doc.

The understanding we were given was it went into the plural cavity. But the explanations that were given on this site make sense.

The N/S was being used to wash out residual pus.

[kids]

Originally posted by Agnus

...Guess that what happens in a small town in an underpopulated state. Anything a little unusual is a big deal here...

I'm not real sure it's a small town thing, I suspect it is pretty rare, the couple of patients I have seen with it were both V.A. patients and I think 1 was a lung Ca on top of it.

-nancy