Cuidados enfermeros al paciente portador de drenaje torácico / Nursing care for patient with thoracic drainage

El drenaje torácico consiste en la colocación de una sonda en el espacio pleural para evacuar la presencia de aire, líquido o sangre, lo cual produce un colapso pulmonar de grado variable con repercusión clínica en función de la reserva ventilatoria previa del paciente y el grado de colapso. Existen varios modelos de tubos torácicos, así como de sistemas de drenaje pleural. Los sistemas cerrados de drenaje torácico actuales son desechables y garantizan un manejo óptimo y seguro para el paciente. Los cuidados de Enfermería son fundamentales durante todo el proceso de instauración de dichos drenajes, tanto en la preparación del paciente, inserción y mantenimiento adecuado para el éxito del tratamiento, como durante la extracción y posterior atención, por lo que conocerlos principios técnicos básicos para una correcta utilización permitirá un mantenimiento eficaz y eficiente del sistema de drenaje y el control, el seguimiento y la evaluación del paciente

Thoracic drainage consists of placing a tube in the pleural cavity to evacuate air, fluid or blood, which leads to pulmonary collapse of a variable degree with a clinical repercussion depending on the patient’s previous ventilation reserve and the extent of collapse. There are several models of thoracic tubes, as well as pleural drainage systems. Current thoracic closed drainage systems are disposable and guarantee optimal and safe patient management. Nursing care is fundamental throughout the process of placement of drainage systems, both in terms of preparation of the patient, insertion and proper maintenance for the success of the treatment, as well as the removal and after-care; therefore, knowledge of the basic technical principles for correct use thereof will enable effective and efficient maintenance of the drainage system and the control, follow-up and evaluation of the patient

Chest drainage.

As an intensive care nurse with experience of caring for critically ill patients in the UK and on deployed operations overseas, I found the CPD article useful in reviewing the pathophysiology of a pneumothorax, use of intrapleural chest drains, observations that should be recorded, and nursing care and management of a patient with an intrapleural chest drain. Reflecting on the time out activities in the CPD article was valuable.

Intrapleural chest drainage.

Abnormal fluid or air between the pleura results in respiratory distress and can cause death, if untreated. Intrapleural chest drains are used to remove abnormal accumulations of fluid or air. Caring for patients with intrapleural chest drains requires knowledge and skill to ensure patient safety. This article describes the pathophysiology, treatment and nursing care of patients who require intrapleural chest drains.

Pleural effusion: diagnosis and management.

Pleural effusion is defined as an accumulation of fluid in the pleural space in excess of 15 to 20 mls. The aetiology for the development of a pleural effusion includes changes in hydrostatic or colloid-osmotic pressure of pleural and pulmonary capillaries, changes in pleural vascular permeability and impaired lymphatic drainage. About 5% to 12% of patients referred for emergency medical treatment are diagnosed with a pleural effusion, making it a common finding on hospital admission. The excess of pleural fluid may be triggered by pleuro-pulmonary infection, malignancy, or conditions of cardiac, renal or hepatic origin. Subsequent management is guided mainly by aetiology and to a lesser degree by symptoms. This paper provides a review of pathophysiology, diagnosis and management of the condition and addresses specific issues regarding the perioperative care of these patients.

Peritoneal and pleural ports for management of refractory ascites and pleural effusions: assessment of impact on patient quality of life and hospice/home nursing care.

PURPOSE: Patients with end-stage malignancies often have refractory ascites or pleural effusions requiring repeated paracenteses or thoracenteses. Subcutaneous peritoneal and pleural port catheters are an alternative therapeutic option. We evaluate the clinical utility of this approach and the impact on quality of life (QOL) and home/hospice care. MATERIALS AND METHODS: Thirty ports were placed, 16 peritoneal and 14 pleural, in patients with a mean age of 62 years. Retrospective chart review and interviews were held with patients and nursing care providers. Mean follow-up was 59 days. RESULTS: On a 10-point scale, QOL improvement, compared to that prior to port placement, was rated a mean of 9.5 by patients and 9.0 by the nursing staff. Both patients and nurses reported a high degree of convenience (rated at 9.7 and 9.6, respectively) and improvement of symptoms and comfort (9.6 and 9.3, respectively). Nursing staff reported a high degree of comfort (9.9) using the aspiration ports. Six of 14 pleural ports were removed following pleurodesis. One pleural port was removed due to patient discomfort and another due to pneumothorax. Two patients with pleural ports developed tumor seeding in the subcutaneous tissues. Of 14 peritoneal ports, 3 required removal for leaking and probable chemical cellulitis. Four became temporarily occluded with patency restored using tissue plasminogen activator (TPA) infusion. CONCLUSIONS: Peritoneal and pleural ports offer a convenient and relatively safe alternative to frequent paracenteses/thoracenteses in the management of refractory ascites and pleural effusions. This approach can improve the QOL for patients with end-stage disease.

Dolor pleurítico en paciente joven / Pleuritic pain in young patient

El dolor pleurítico es la manifestación clínica de múltiples patologías intra y extrapulmonares, de ahí la importancia de una buena anmnesis y exploración inicial para orientar el diagnóstico. En este caso, el paciente, un joven de 21 años, comienza con un dolor en hemitórax derecho de carácter pleurítico tras un esfuerzo moderado en el instituto. Visto inicialmente por su médico de Atención Primaria, es derivado al hospital para valoración radiológica. El enfoque de estos casos debe ser integral, desde que es visto en consulta hasta su derivación al hospital. Una vez en el hospital debe ser reevaluado para descartar posibles etiologías y hacer un diagnóstico diferencial. En este caso, tras los hallazgos exploratorios se realizó una radiografía de tórax en 2 proyecciones para descartar neumotórax. El tratamiento de este tipo de pacientes consiste en el drenaje pleural cerrado del aire contenido entre ambas pleuras, parietal y visceral, evidenciándose en la mayoría de los casos una clara mejoría clínica y la resolución del problema. Tas el drenaje, según las condiciones basales del individuo, son derivados a su domicilio y referidos para seguimiento ambulatorio a las 48 horas, así como para la realización de una radiografía de control. Existe una tasa de recidivas del 30%, según diferentes estudios, llegando al 80% según las características previas del paciente. La mayoría de estos neumotórax son espontáneos o primarios, asociándose entre otros, con roturas de blebs pulmonares de etiología desconocida. Generalmente si se diagnostican a tiempo los neumotórax espontáneos, los más frecuentes, presentan un buen pronóstico al alta, no precisando más intervenciones posteriores (AU)

Pleuritic pain is the clinical manifestation of multiple intra and extrapulmonary diseases which is why a good anamnesis and initial examination are important to orient the diagnosis. This is the case of a 21 year old male patient who began with pleuritic pain in the right hemithorax after moderate exertion at school. He was initially seen by his medical practitioner and then sent to the hospital for X-ray evaluation. These cases should be given a comprehensive approach from the time the patient goes to the consultation until his/her referral to the hospital. Once in the hospital, the patient should be re-evaluated to rule out possible etiologies and make a differential diagnosis. In this case, after the medical examination, a chest X-ray with 2 projections was made to rule out pneumothorax. This type of patient is treated by closed pleural drainage of the air contained between the parietal and visceral pleuras, clear clinical improvement and problem resolution being found in most of the cases. After the drainage, according to the baseline conditions of the subject, they are sent home and referred for out-patient follow-up at 48 hours and a control X-ray. There is a 30% relapse rate according to the different studies, this reaching 80% according to the previous characteristics of the patient. Most of these pneumothoraxes are spontaneous or primary, with associations, among others, of ruptures pulmonary bleb of unknown etiology. If diagnosed on time, the spontaneous pneumothoraxes, the most frequent, generally have a good prognosis on discharge, and do not require subsequent interventions (AU)

Pleural effusion: nursing care challenge in the elderly.

Pleural effusion is excess collection of fluid in the pleural cavity. It is a frequent complication of pneumonia, congestive heart failure, and carcinomas of the lung, breast, and ovaries. Regardless of the cause, pleural effusion produces significant effects on the respiratory system, especially when considering the normal age-related changes that compromise the respiratory system. Pleural effusion and the complexity of diagnosis and treatment make planning and delivering care challenging. The article describes the pathophysiology of pleural effusion, its management, and related nursing care priorities.

[Pathophysiological changes in a lung cancer patient suffering from pleural effusion: a case analysis].

Pleural effusion--perhaps the most common and serious complication among lung cancer patients--causes dyspnea, chest pain, and coughing, leading to a painful series of examinations, treatments, and additional complications. This exerts a strong effect on the functional status and psychological well-being of cancer patients, requiring special treatment responses on the part of nursing professionals. The authors introduce concepts related to pathophysiology, etiology, and the clinical assessment of pleural effusion, using a single case study to compare clinical data with theoretical and empirical knowledge. An individualized nursing intervention developed for this particular case is presented and discussed.

Assessment of infants with peripherally inserted central catheters: Part 2. Detecting less frequently occurring complications.

Peripherally inserted central catheters (PICCs) are frequently placed in neonates to optimize nutrition and provide stable infusions of critical medications into the central vascular system. PICCs have been associated with a number of device-specific complications that can manifest during insertion, while the line is indwelling, and/or after the removal of the line. The first article of this series in Focus on the Physical, titled "Assessment of Infants With Peripherally Inserted Central Catheters: Part I. Detecting the Most Frequently Occurring Complications," presented assessment strategies to detect common complications such as catheter occlusions and catheter-related bloodstream infections. Part 2 of this series emphasizes the importance of ongoing systematic assessment of PICCs for device-specific complications such as catheter migration, dislodgement, breakage, phlebitis, and thrombosis, as well as the life-threatening complications of pleural and pericardial effusion and tamponade. Each complication is described, along with a review of the etiology, a description of presenting signs and symptoms, and key clinical interventions.

Mobile chest drainage: coming soon to a home near you.

Home care nurses are seeing more patients with chest drainage devices than ever before. This article reviews the conditions that may be treated at home with mobile chest drainage devices, specific devices nurses are likely to see in the home, focused nursing assessments, tips for monitoring the devices, and key aspects of patient and caregiver teaching.

Intrapleural fibrinolytic therapy for complicated pleural effusions.

Intrapleural administration of fibrinolytic agents can be used to degrade the fibrin present in complicated pleural effusions, thus decreasing viscosity of the fluid and enhancing evacuation of the pleural space via chest tube drainage. Patients who may otherwise need surgical intervention could benefit from this treatment. As more knowledge is gained through clinical experience and research studies, patients' outcomes may show major improvement.