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assessing and examining the bronchi which is used for therapeutic and diagnostic purposes
brnchoscopy
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consist of a hollow metal tube with a light on its distal end
rigid
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rigid bronchoscope is useful for
- removing aspirated foreign bodies
- thick secretions from the lungs
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consist of a collection of thing, threadlike glass strands called fiberoptic filaments with a light source profected to its distal end
fiberoptic
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which bronchoscope is tolerated by pts
fiberoptic
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what is the commonly sedative given to pt that needs bronchoscopy
- diazepam-- valium
- midazolam-- versed
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the level of sedation, referred to as
conscious sedation, should be just enough to allow the pt to follow commands yet still be comfortable
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the airway must be dry during the procedure to air in visualization, which is usually achieved by administering
- atropine, 1 to 2 hrs between procedure.
- atropine may also decrease vagal tone, resulting dec potential for bradycardia and hypotension
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where can the tube be inserted
- orally
- nasally
- throught the ett
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what is used both as lubricant and for anesthetic effects
lidocaine-- xylocaine
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indications for bronchoscopy
- removal of foreign bodies
- removal of mucu plugs and thick secretions
- atelectasis that affects a lobe or entire lung
- pulm hemorrhage
- when tracheal intubation is difficult
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complications of bronchoscopy- 8
- hypoxemia
- laryngospasm
- bronchospasm
- arrhythmias
- hemorrhage
- resp depression
- hypotension
- pneumothorax
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used to drain substance that accumulate in the pleural space
chest tubes
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what are some of the substances that can accumulate in the pl space
- air
- blood
- lymph
- serous fluid
- pus
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serous fluid-
pl effusion
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pus-
pyothorax or empyema
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** to help evacuate air (pneumothorax) from the pleural space, the chest tube is usually inserted in the
second, third, or 4th intercostal space
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** to remove fluid, the tube is usually inserted in the
placed lower, 6th or 7th intercostal space
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if the proximal hole on the chest tube slips out of the chest, air enters the tube resulting in
bubbling in the system, which appears to be a persistent leak in the lung
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fluid or air drains from the pl space through the chest tube and enters the drainage bottle through a glass tube, which is submerged under water. this forms a seal that acts like a ONE WAY valve to prevent air from entering the pl cavity
one bottle system
(WATER SEAL AND DRAINAGE BOTTLE)
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collects air exiting the pl space. liquid drans into the first bottle. purpose of this system is to better control the amt of suction applied. suction source may be connected to the vent of the water seal bottle
2 bottle system
(WATER SEAL AND DRAINAGE BOTTLE & SUCTION CONTROL BOTTLE)
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determine the amt of SUBATMOSPHERIC PRESSURE in the water seal bottle. amt of suction is determined by how far under water the tube is submerged. suction source may be attached also
3 bottle system
(DRAINAGE BOTTLE & WATER SEAL BOTTLE & SUCTION CONTROL BOTTLE)
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what is the most commom chest tube drainage system
pleur-evac = plastic threee chambered system
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what does it mean if theres no fuctuation occuring in the water seal bottle
obstruction of the tube should be suspected
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obstructed chest tube may results in
tension pneumothorax
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what should you do to ensure ADEQUATE drainage and TUBE PATENCY
strip or milk the tube every 1 to 2 h
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occasional bubbling in the water seal bottle is
normal as air enters from the pl space
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absense of bubbling indicates that
no air is being removed from the pl space, which is a sign of the pts improvements
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if an air leak is suspected, the chest tube should be
clamped to identify the source of the leak
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the glass tube MUST ALWAYS be kept
submerged under the water
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