Indications & Management of ICC’s & UWSD’S Nardine Johnson CDN SAPU Surgical assessment & Planning Unit March 2013

Learning Objectives Revise the Anatomy & Physiology of the lungs Understand the Indications for insertion of an Intercostal Catheter Demonstrate correct setup of UWSD Understand the Nursing management of an ICC & UWSD

Anatomy & Physiology Identification of key anatomy is vital when caring for an ICC; Larynx Trachea R) & L) main Bronchus Carina Secondary & Tertiary Bronchus Alveoli Visceral pleura & Parietal pleura Diaphragm Ribs & Intercostal spaces

Respiratory Pressures Respiratory pressures- described relative to atmospheric pressure. Atmospheric pressure is the pressure exerted by the air surrounding the body. Intrapulmonary pressure, the pressure rises & falls with the respiratory cycle, always equalises with atmospheric.

Physiology On Inspiration, pressure in pleural space becomes more negative(from –3cmH20 to –6H20). Pressure allows air to enter the lungs. On Expiration, pressure in pleural space becomes less negative. Pressure equalisation causes air to exit the lungs.

Indications for an Intercostal Catheter The accumulation of air, fluid or blood into the pleural space caused by; Injury- Chest trauma, i.e. Motor vehicle accident Medical Problems- spontaneous pneumothorax, bleb rupture, Cancer related. Surgical- Thoracotomy, VAT.

Indications Pneumothorax- a collection of gas or air in the pleural space causing the lung to collapse. Pleural effusion- a buildup of fluid between the layers of tissue that line the lungs and chest cavity Haemo pneumothorax- An accumulation of blood & air in the pleural cavity.

Tension Pneumothorax- A condition of air in the intrapleural space of the thorax caused by rupture of the chest wall & which the air is retained in the pleural space with no escape.

Signs of a Tension pneumothorax; mediastinal shift, overexpanded chest, shallow gasping respiration, tracheal deviation & changes in arterial pulse.

Tension Pneumothorax

Further Indications Hemothorax- An accumulation of blood & fluid in the pleural cavity, between the visceral & parietal pleura. Open Pneumothorax- open cavity directly thru to pleural cavity, “sucking” wound of the chest.

Atrium Dry suction Chest drain used for evacuation of air/& or fluid from chest cavity, re-establish lung expansion.

Setup of Atrium 1. Fill water seal to 2cm line- twist top off bottle & insert tip into suction port, squeeze contents into water seal until fluid reaches 2cm fill line. 2. Connect patient Tube to patient 3. Connect Suction to chest drain 4. Adjust dry suction regulator, preset to -20cmH20, can be adjusted from -10cmH20 to -40cmH20. 5. Turn suction source on

Instructions for use Suction bellows, will expand to the ▲mark or beyond when suction is connected & operating. Water seal, must be filled to 2cm line for system operation & air leak detection, once filled seal becomes tinted blue. Air leak monitor, air leak bubbling can range from 1(low) to 5(high), can monitor pattern

Sampling drainage, needle-less Luer port on patient tube connector.

Nursing Management Observations- Bubble/Air leak, observed in the water seal chamber, indicates air in the pleural space, or a system leak. To check disconnect from suction, instruct pt to take a deep breath & cough out, observe if bubbling is continuous, intermittent or absent NOTE- The patient must have 2 Howard kelly clamps with them at all times

Bubbling occurs as a result of the air escaping from the pleural space & then being trapped by the water seal to prevent re-entry back into the pleural space.

Swing/Oscillation, measured in the water seal chamber Swing/Oscillation, measured in the water seal chamber. Fluctuations in the fluid level swing) are caused by the changes in intrapleural pressure. To check disconnect from suction, deep breath in & out. No swing may be caused by obstruction of the tube or full expansion of the lung occluding eyelets in the tube.

Drainage, is usually blood, hemoserous or serous Drainage, is usually blood, hemoserous or serous. To check observe level of fluid, type, calculate hourly drainage, ensure tubing is not kinked or looped, >100ml/hr= heavy drainage.

Dressing Occlusive, clear dressing- It is better if it is clear so we can see any ooze & what colour it is. Should be attended daily. Drain sponge, Tegaderm, leukoplast at connections & to secure to patients skin.

Heimlich Valve

Thankyou!!!!