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Pemasangan Thorax Tube Aida Yulia Amany

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Chest Tube Insertion stase bedah

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Pemasangan Thorax TubeAida Yulia AmanyThoracic CavityBatas batas cavitasthoraxAnterior = sternumPosterior = vertebra thorakalLateral = ribsInferior = diafragma

Thoracic CavityRight lungLeft lungMediastinumHeartAorta & great vesselsEsofagusTrachea

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

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

Pleural AnatomyParu paru dilapisi oleh pleuraParietal pleura : melapisi dinding dadaVisceral pleura : melapisi paru paruRuang diantara kedua pleura disebut spatium pleura atau cavum pleura

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

Indikasi pemasangan thorax tube

PneumothoraxUdara pada cavum pleuraIndikasi pemasangan thorax tubeHemothoraxDarah pada cavum pleura

Indikasi pemasangan thorax tubePleural effusionTransudat / eksudat padacavum pleura

Kontraindikasi Pemasangan Thorax TubeInfeksi pada lokasi pemasanganGangguan pembekuan darah yang tak terkontrolEquipmentChest tube drainage device with water sealSuction source and tubingSterile glovesPreparatory solutionSterile drapesSurgical markerLidocaine 1% with epinephrineSyringes, 10-20 mL (2)Needle, 25 gauge (ga), 5/8 inNeedle, 23 ga, 1.5 in; or 27 ga, 1.5 in; for instilling local anesthesiaBlade, No. 10, on a handleLarge and medium Kelly clampsLarge curved Mayo scissorsLarge straight suture scissorsSilk or nylon suture, 0 or 1-0Needle driverVaseline gauzeGauze squares, 4 x 4 in (10)Sterile adhesive tape, 4 in wideChest tube of appropriate sizeMan - 28-32FWoman - 28FChild - 12-28FInfant - 12-16FNeonate - 10-12F

Equipment

Memposisikan PasienPosisikan pasien dalam keadaan supine atau 45oAbduksikan 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 TubeAdminister local anasthesia

Langkah Pemasangan Thorax TubeSkin incission approximately 4 cm longShould be in the same direction as the rib itself

Langkah Pemasangan Thorax TubeBlunt dissection using Kelly clamp down to intercostal muscle

Langkah Pemasangan Thorax TubePalpation of the selected intercostal space and the superior margin of its inferior rib

Langkah Pemasangan Thorax TubeA 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 TubeA finger is used to palpate the tract and feel for adhesions before insertion of the chest tube.

Langkah Pemasangan Thorax TubeThe 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 TubeA 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 TubeApply support gauze dressing around the chest tube and secure it to the chest wall with 4-in adhesive tapeChest tube in good position.

Thorax Drainage System

Bagaimana cara kerja sistem drainase?Thorax Drainage System

Hanya bisa digunakan untuk pneumothoraxTube open to atmosphere vents air Tube from patientThorax Drainage System The first bottle collects the drainageThe second bottle is the water sealWith an extra bottle for drainage, the water seal will then remain at 2cm

Tube open to atmosphere vents air Tube from patientThorax Drainage System

Fluid drainTube from patientTube open to atmosphere vent airTube to vacuum sourceStraw under 20cm H20Thorax Drainage System Keep drain below the chest for gravity drainageFluid, like air, moves from an area of higher pressure to an area of lower pressure

Komplikasi Pemasangan Thorax TubeImproper placementPerdarahanHemoperitoneumliver atau splen injury, segera laparotomy emergencyPenetrasi organbiasanya membutuhkan repair surgery

Komplikasi Pemasangan Thorax TubeTube dislodgementEmpyema chest tube bisa mengakibatkan masuknya bakteri ke cavum pleuraRetained pneumothorax atau hemothorax

ReferenceGil Z Shlamovitz. 2014.Tube Thoracostomy. Diakses dari http://emedicine.medscape.com/article/80678Queens university. 2012. Tube Thoracostomy. Queens University : Dept. Of Emergency MedicineAmerican Thoracic Society. 2013. Chest Tube Thoracostomy. Respir Crit Care Med Vol. 170