Needlessly Treated: Evaluation of Prehospital Needle Thoracostomy.

BACKGROUND: Needle thoracostomy is a potentially life-saving intervention for tension pneumothorax but may be overused, potentially leading to unnecessary morbidity. OBJECTIVE: To review prehospital needle thoracostomy indications, effectiveness, and adverse outcomes. METHODS: A retrospective cohort study was conducted based on registry data for a United States Midwestern Level I trauma center for a 7.5-year period (January 2015 to May 2022). Included were patients who received prehospital needle thoracostomy and trauma activation before hospital arrival. The primary outcomes were correct indications and improvement in vital signs. Secondary outcomes were the need for chest tubes, correct needle placement, complications, and survival. RESULTS: A total of n = 67 patients were reviewed, of which n = 63 (94%) received a prehospital thoracostomy. Of the 63 prehospital thoracostomies, 54 (86%) survived to arrival. Of these 54, 44 (n = 81%) had documented reduced/absent breath sounds, 15 (28%) hypotension, and 19 (35%) with difficulty breathing/ventilating. Only four patients met all three prehospital trauma life support criteria: hypotension, difficulty ventilating, and absent breath sounds. There were no significant changes in prehospital vitals before and after receiving needle thoracostomy. In patients receiving imaging (n = 54), there was evidence of 15 (28%) lung lacerations, 6 (11%) of which had a pneumothorax and 3 (5%) near misses of important structures. Review of needle catheters visible on computer tomography imaging found 11 outside the chest and 1 in the abdominal cavity. CONCLUSION: The study presents evidence of potential needle thoracostomy overuse and morbidity. Adherence to specific guidelines for needle decompression is needed.

Managing a chest tube and drainage system.

Intercostal drainage tubes (ie, chest tubes) are inserted to drain the pleural cavity of air, blood, pus, or lymph. The water-seal container connected to the chest tube allows one-way movement of air and liquid from the pleural cavity. The container should not be changed unless it is full, and the chest tube should not be clamped unnecessarily. After a chest tube is inserted, a nurse trained in chest-tube management is responsible for managing the chest tube and drainage system. This entails monitoring the chest-tube position, controlling fluid evacuation, identifying when to change or empty the containers, and caring for the tube and drainage system during patient transport. This article provides an overview of indications, insertion techniques, and management of chest tubes.

Management of the patient undergoing lung transplantation: an intensive care perspective.

The postoperative management of a patient undergoing lung transplantation involves many components of care. These components include ventilatory and hemodynamic management, immunosuppression, wound care, rehabilitation, infection control and treatment, and early detection of rejection.

Clinical case: Nursing care of an inmate with thoracic window.

OBJECTIVE: To make a comprehensive assessment of a pacient who has a thoracoscopy or thoracic window that needs wound care. Through the functional patterns of Marjory Gordon and the NANDA taxonomy (North American Nursing Diagnosis Association), NIC (Nursing Interventions Classification), and NOC (Nursing Outcomes Classification). As well as helping the healing and closing time of the wound to be shorter, reducing the risk of infection and improving the quality of life of the patient. CASE PRESENTATION: The clinical case of the patient with thoracic window is described. The real and potential diagnoses were established, some objectives or NOC were set and the necessary activities or NIC were carried out to reach them. RESULTS: On a Likert scale (1 to 5), a wound healing was obtained, from 1 to 3, a level of anxiety, from 3 to 4, a problem coping, from 3 to 4, a level of self-care, from 2 to 4, the promotion of health, from 2 to 4, and the therapeutic regimen, from 2 to 4, after one year of follow-up. CONCLUSIONS: The comprehensive approach that should be performed to the patient, not focused only on the reason for the consultation, but assessing the different functional patterns to know which are altered and take into account the evolution of the process and better care and quality improvement of the patient's life.

Nursing management of patients with a chest drain.

Chest drains incorporate the use of a one-way valve to drain fluid or air from the pleural cavity. The valve prevents back-flow of air and fluid into the pleural cavity. They are indicated for use when collections of fluid or air are present in the pleural space, and by draining the collection they restore efficient gaseous exchange. Little has been written on the nursing management of chest drains and the literature highlights a lack of national standardized guidelines for due to the range of thoracic conditions encountered by clinical staff. Themes such as pain management and mechanism of breathing occur frequently; however, there is a lack of up-to-date literature for the nurse to refer to. This article examines the nursing role in chest drain management from insertion to removal and includes aspects of pain management and features of a functioning chest drain.

Chest drain removal.

This article provides a step-by-step approach to the removal of chest drains and offers a rationale for practice. It also discusses indications for chest drain removal and potential complications associated with the procedure.

Thoracostomy Tube Removal: Implementation of a Multidisciplinary Procedural Pain Management Guideline.

OBJECTIVE: Thoracostomy tubes are placed following cardiothoracic surgery for the repair or palliation of congenital heart defects. The aim of this project was to develop and implement a clinical practice guideline for the provision of optimal analgesia during removal of thoracostomy tubes in pediatric postoperative cardiothoracic surgery patients. METHODS: Methods used include a nonexperimental design utilizing chart audits to determine baseline documentation as well as procedure note evaluation to determine both baseline documentation and compliance with the new guideline. A convenience sample of unit-based nurses completed a knowledge test and a post-implementation survey. RESULTS: There was a significant increase in nursing knowledge related to the clinical practice guideline education and implementation. Documentation compliance was observed. Nursing satisfaction and feasibility of the new guideline was demonstrated. DISCUSSION: This project was successful in increasing nursing knowledge of available resources for optimal procedural pain management in pediatric patients requiring thoracostomy tube removal on one in-patient acute care unit.

Refining chest tube management: analysis of the state of practice.

Critical care nurses routinely care for patients who require chest tube management. To obtain the best patient outcome, critical care nurses develop standards of practice from research derived recommendations. Although there are several studies recommending chest tube management practices, there is limited research in some areas of chest tube management. The authors analyze the body of research and recommend clinical practice changes and timely research projects on chest tube management.

Care of the patient with Clagett open-window thoracostomy.

The Clagett open-window thoracostomy is performed to give patients with empyema improved quality of life and other outcomes. Adult health nurses care for patients undergoing this procedure preoperatively, postoperatively, and at home, and must consider several important issues to prevent serious complications and facilitate family care.

Nursing management of chest drains.

This article provides an overview of the essential physiology of the respiratory system to enhance understanding of the principles of intrapleural drainage. Indications for chest drain insertion, related signs and symptoms, potential complications and nursing reponsibilities are discussed.

Exploring chest drain options.

The variety of chest drainage systems now available makes it more important than ever for nurses to understand what's out there and how these systems work. Nurses are responsible for managing chest drains and need to know which drain is best suited for which situation.

Caso clínico: cuidados de enfermería en un interno con ventana torácica / Clinical case: nursing care of an inmate with thoracic window

Objetivos: hacer una valoración integral de un paciente que presenta una toracostomía o ventana torácica, que precisa de cuidados de la herida a través de los patrones funcionales de Marjory Gordon y la taxonomía NANDA (North American Nursing Diagnosis Association), NIC (Nursing Interventions Classification) y NOC (Nursing Outcomes Classification), así como ayudar a que el tiempo de cicatrización y cierre de la herida sea más corto, reduciendo el riesgo de infección y mejorando la calidad de vida del paciente. Presentación del caso: se describe el caso clínico del paciente con ventana torácica. Se establecieron los diagnósticos reales y potenciales, se fijaron unos objetivos (NOC) y se realizaron las actividades necesarias (NIC) para alcanzarlos. Resultados: en una escala de tipo Likert, con rangos de medición del 1 al 5, se obtuvo una curación de la herida del 1 al 3, un nivel de ansiedad del 3 al 4, un afrontamiento de problemas del 3 al 4, un nivel de autocuidado del 2 al 4, el fomento de la salud del 2 al 4, y el régimen terapéutico del 2 al 4, tras un año de seguimiento. Conclusiones: el abordaje integral que se debe realizar al paciente no debe centrarse solo en el motivo de la consulta, sino que es necesario también valorar los distintos patrones funcionales, para saber cuáles están alterados y tener en cuenta la evolución del proceso, la mejor atención y la mejora de la calidad de vida del paciente

Objective: to make a comprehensive assessment of a pacient who has a thoracoscopy or thoracic window that needs wound care. Through the functional patterns of Marjory Gordon and the NANDA taxonomy (North American Nursing Diagnosis Association), NIC (Nursing Interventions Classification), and NOC (Nursing Outcomes Classification). As well as helping the healing and closing time of the wound to be shorter, reducing the risk of infection and improving the quality of life of the patient. Case presentation: the clinical case of the patient with thoracic window is described. The real and potential diagnoses were established, some objectives or NOC were set and the necessary activities or NIC were carried out to reach them. Results: on a Likert scale (1 to 5), a wound healing was obtained, from 1 to 3, a level of anxiety, from 3 to 4, a problem coping, from 3 to 4, a level of self-care, from 2 to 4, the promotion of health, from 2 to 4, and the therapeutic regimen, from 2 to 4, after one year of follow-up. Conclusions: the comprehensive approach that should be performed to the patient, not focused only on the reason for the consultation, but assessing the different functional patterns to know which are altered and take into account the evolution of the process and better care and quality improvement of the patient's life

Chest tubes in the critically ill patient.

This article is meant as a review for critical care nurses caring for patients with chest tubes. The types of chest tubes, equipment needed, types of chest drainage systems, chest tube placement and setup, nursing care, chest tube removal, and complications will be discussed.