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Pemasangan Thorax Tube

Aida Yulia Amany

Thoracic Cavity
Batas batas cavitas
thorax
Anterior = sternum
Posterior =
vertebra thorakal
Lateral = ribs
Inferior =
diafragma

Thoracic Cavity
Right lung
Left lung
Mediastinum
Heart
Aorta & great
vessels
Esofagus
Trachea

Breathing : Inspirasi
Diafragma
berkontraksi, vol cav
thorax , tekanan
intrapulmoner
Udara dari luar
memiliki tekanan lebih
tinggi masuk ke paru
yang tekanannya lebih
rendah

Breathing : Ekspirasi
Diafragma relaksasi,
vol cav thorax
tekanan
intrapulmoner
Udara mengalir keluar
dari paru menuju ke
luar yang tekanannya
lebih rendah

Pleural Anatomy
Paru paru dilapisi oleh pleura
Parietal pleura : melapisi dinding dada
Visceral pleura : melapisi paru paru
Ruang diantara kedua pleura disebut spatium
pleura atau cavum pleura

Thorax Tube
Tube thoracostomy, thoracic catheter,
chest drain, intercostal drain
Adalah sebuah selang elastis yang
dimasukkan pada cavum pleura melalui
dinding dada untuk mengeluarkan udara,
darah, pus, dan cairan lainnya

Indikasi pemasangan thorax


tube

Pneumothorax
Udara pada cavum
pleura

Indikasi pemasangan thorax


tube

Hemothorax
Darah pada cavum
pleura

Indikasi pemasangan thorax


tube

Pleural effusion
Transudat / eksudat
pada
cavum pleura

Kontraindikasi Pemasangan
Thorax Tube
Infeksi pada lokasi pemasangan
Gangguan pembekuan darah yang tak
terkontrol

Equipment
Chest tube drainage device with
water seal
Suction source and tubing
Sterile gloves
Preparatory solution
Sterile drapes
Surgical marker
Lidocaine 1% with epinephrine
Syringes, 10-20 mL (2)
Needle, 25 gauge (ga), 5/8 in
Needle, 23 ga, 1.5 in; or 27 ga,
1.5 in; for instilling local
anesthesia
Blade, No. 10, on a handle
Large and medium Kelly clamps

Large curved Mayo scissors


Large straight suture scissors
Silk or nylon suture, 0 or 1-0
Needle driver
Vaseline gauze
Gauze squares, 4 x 4 in (10)
Sterile adhesive tape, 4 in
wide
Chest tube of appropriate size
Man - 28-32F
Woman - 28F
Child - 12-28F
Infant - 12-16F
Neonate - 10-12F

Equipment

Memposisikan Pasien
Posisikan pasien
dalam keadaan
supine atau 45o
Abduksikan lengan
dan rotasikan
eksternal lalu
letakkan telapak
tangan di belakang
kepala

Langkah Pemasangan Thorax Tube


Skin preparation and
marking.
The skin incision is made
in between the midaxillary
and anterior axillary lines
over a rib that is below the
intercostal level selected
for chest tube insertion.

Langkah Pemasangan Thorax Tube

Administer local anasthesia

Langkah Pemasangan Thorax Tube

Skin incission
approximately 4 cm long
Should be in the same
direction as the rib itself

Langkah Pemasangan Thorax Tube

Blunt dissection using Kelly


clamp down to intercostal
muscle

Langkah Pemasangan Thorax Tube

Palpation of the selected


intercostal space and the
superior margin of its
inferior rib

Langkah Pemasangan Thorax Tube


A closed and locked Kelly
clamp is used to enter the
chest wall into the pleural
cavity. Make sure to guide
the clamp over the upper
margin of the rib.

Once the Kelly clamp enters


the pleural cavity, the
clamp should be opened to
further enlarge the opening.

Langkah Pemasangan Thorax Tube

A finger is used to palpate


the tract and feel for
adhesions before insertion
of the chest tube.

Langkah Pemasangan Thorax Tube


The proximal end of the
chest tube is held with a
Kelly clamp that is used to
guide the chest tube
through the tract.

The distal end of the chest


tube should always be
clamped until it is
connected to the drainage
device.

Langkah Pemasangan Thorax Tube


A 0 or 1-0 silk or nylon
suture is used to secure the
chest tube to the skin.

Apply petrolatum (eg,


Vaseline) gauze over the
skin incision.

Langkah Pemasangan Thorax Tube


Apply support gauze
dressing around the chest
tube and secure it to the
chest wall with 4-in
adhesive tape

Chest tube in good position.

Thorax Drainage System


Bagaimana cara kerja sistem
drainase?

Thorax Drainage System


Tube open
to
atmosphere
vents air

Tube from
patient

Hanya bisa
digunakan untuk
pneumothorax

Thorax Drainage System


Tube open
to
atmosphere
vents air

Tube from
patient

The first bottle


collects the
drainage
The second bottle
is the water seal
With an extra
bottle for drainage,
the water seal will
then remain at
2cm

Thorax Drainage System


Tube to
vacuum
source

Straw
under
20cm H20

Tube open to
atmosphere
vent air

Tube from
patient

Fluid drain

Thorax Drainage System


Keep drain below
the chest for
gravity drainage
Fluid, like air,
moves from an
area of higher
pressure to an area
of lower pressure

Komplikasi Pemasangan Thorax


Tube
Improper placement
Perdarahan
Hemoperitoneum
liver atau splen injury, segera laparotomy
emergency
Penetrasi organ
biasanya membutuhkan repair surgery

Komplikasi Pemasangan Thorax


Tube
Tube dislodgement
Empyema
chest tube bisa mengakibatkan
masuknya bakteri ke cavum pleura
Retained pneumothorax atau
hemothorax

Reference
Gil Z Shlamovitz. 2014.Tube Thoracostomy.
Diakses dari
http://emedicine.medscape.com/article/80
678
Queens university. 2012. Tube
Thoracostomy. Queens University : Dept.
Of Emergency Medicine
American Thoracic Society. 2013. Chest
Tube Thoracostomy. Respir Crit Care Med
Vol. 170