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CHEST DRAINAGE PRODUCT TRAINING COURSE Richard Švec, M.D. Training overview. Anatomy, physiology and mechanics of breathing Pneumothorax, Haemothorax Principles of underwater seal chest drainage From the bottle system to CDU Chest drainage products (features and benefits). - PowerPoint PPT Presentation
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CHEST DRAINAGEPRODUCT TRAINING COURSE
Richard Švec, M.D.
CHEST DRAINAGEPRODUCT TRAINING COURSE
Richard Švec, M.D.
Training overviewTraining overview• Anatomy, physiology and mechanics of Anatomy, physiology and mechanics of
breathingbreathing• Pneumothorax, HaemothoraxPneumothorax, Haemothorax• Principles of underwater seal chest Principles of underwater seal chest
drainagedrainage• From the bottle system to CDUFrom the bottle system to CDU• Chest drainage products (features and Chest drainage products (features and
benefits)benefits)
Anatomy of the Chest CavityAnatomy of the Chest Cavity
Left LungLeft Lung
PericardiumPericardium
IntrapleuralIntrapleuralspacespace
IntrapleuralIntrapleuralspacespace
Right LungRight Lung
TracheaTrachea
DiaphragmDiaphragm
MediastinumMediastinum
Zoom
LungLung
VisceralVisceralpleurapleura ChestChest
wallwall
ParietalParietalpleurapleura
Intrapleural spaceIntrapleural space
Intrapleural SpaceIntrapleural Space
Principles of RespirationPrinciples of Respiration
The pressure of a given quantity of gas is inversely proportional to its volume.
Principles of RespirationPrinciples of Respiration
Increasing volume causes a decrease in pressure, whichcauses air to rush in as the pressures reach equilibrium.
Principles of RespirationPrinciples of Respiration
Decreasing volume causes an increase in pressure, whichcauses air to be expelled as pressures reach equilibrium.
Passive organ (can not make any movements by itself)Needs to be expanded to work
Expansion of the lungs is achieved by:• Negative intrapleural pressure• Lung surface tension
Air inlet/outlet into/from lungs isachieved by:• Increase/Decrease of the volume of the chest cavity (Boyle´s law)
Passive organ (can not make any movements by itself)Needs to be expanded to work
Expansion of the lungs is achieved by:• Negative intrapleural pressure• Lung surface tension
Air inlet/outlet into/from lungs isachieved by:• Increase/Decrease of the volume of the chest cavity (Boyle´s law)
The LungsThe LungsThe LungsThe Lungs
Mechanics of RespirationMechanics of RespirationInspiration process
Air in Contraction of diaphragm and intercostal muscles
Increase of the negative intrapleural presure
Expansion of the lungs
Air inlet to lungsAir inlet to lungs
Air out
Relaxation of diaphragm and intercostal muscles
Decrease of the negative intrapleural presure
Relaxation of the lungs
Air outlet from lungsAir outlet from lungs
Mechanics of RespirationMechanics of RespirationExpiration process
Abnormal ConditionsAbnormal Conditions• Violation of the closed system of the thoracic cavityViolation of the closed system of the thoracic cavity• Loss of the negative intrapleural pressureLoss of the negative intrapleural pressure• Accumulation of air in the intrapleural spaceAccumulation of air in the intrapleural space• Accumulation of fluid in the intrapleural spaceAccumulation of fluid in the intrapleural space
PARTIAL OR FULL LUNG COLLAPSEPARTIAL OR FULL LUNG COLLAPSEDIMINISHED RESPIRATIONDIMINISHED RESPIRATION
TREATMENT NEEDEDTREATMENT NEEDED
!! !!
TerminologyTerminologyPneumothoraxPneumothorax• accumulation of air in the pleural spaceaccumulation of air in the pleural space
HaemothoraxHaemothorax• accumulation of blood in the pleural spaceaccumulation of blood in the pleural space
HaemopneumothoraxHaemopneumothorax• accumulation of air and blood in the pleural spaceaccumulation of air and blood in the pleural space
FluidothoraxFluidothorax• accumulation of any other fluid (matter) in pleural accumulation of any other fluid (matter) in pleural spacespace
HaemomediastinumHaemomediastinum• accumulation of blood in mediastinumaccumulation of blood in mediastinum
• External pneumothoraxExternal pneumothorax Opening in the chest wall. Air directly enters and Opening in the chest wall. Air directly enters and leaves the intrapleural space - open communication.leaves the intrapleural space - open communication. Loss of negative intrapleural pressure. 0Loss of negative intrapleural pressure. 0
• Internal pneumothoraxInternal pneumothorax Opening in the lung. Air enters and leaves intrapleuralOpening in the lung. Air enters and leaves intrapleural space through lung. Loss of negative intrapleural space through lung. Loss of negative intrapleural pressure. 0pressure. 0
•Tension pneumothorax (Valve pneumothorax)Tension pneumothorax (Valve pneumothorax) Opening in the lung or chest wall. Air enters the Opening in the lung or chest wall. Air enters the intrapleural space but can not leave out. Building ofintrapleural space but can not leave out. Building of possitive intrapleural presure. (+) !!!!!!possitive intrapleural presure. (+) !!!!!!
PneumothoraxPneumothorax
PneumothoraxPneumothoraxOpening in chest wallOpening in chest wall
AIRAIR
Loss of the negative intrapleural pressureLoss of the negative intrapleural pressure
Collapse of the lungsCollapse of the lungs
Opening in the chestOpening in the chestwallwall
Trauma, operationTrauma, operation
OpenOpencommunicationcommunication
TraumaTrauma
Opening in the lungOpening in the lung
Loss of the negative Loss of the negative intrapleural pressureintrapleural pressure
Collapse of the lungsCollapse of the lungs
Tension PneumothoraxTension PneumothoraxOne way (valve)One way (valve)Opening in lungOpening in lung
AIRAIR
Risk of building of positive intrapleural Risk of building of positive intrapleural presure !!presure !!Risk of mediastinal shift !!!Risk of mediastinal shift !!!
Pneumothorax, HaemothoraxPneumothorax, Haemothorax
Objectives of treatmentObjectives of treatment
• Removal of airRemoval of air• Removal of fluidRemoval of fluid• Re-building of negative intrapleural pressureRe-building of negative intrapleural pressure
Lung re-expansionLung re-expansion
Pneumothorax, HaemothoraxPneumothorax, Haemothorax
Method of treatmentMethod of treatmentMethod of treatmentMethod of treatment
UNDERWATER SEALTHORACIC DRAINAGEUNDERWATER SEAL
THORACIC DRAINAGE
Underwater SealUnderwater SealChest drainageChest drainage
To the drainage system
•Provides means for air and fluid to escape the chest cavity
•Prevents air from re-entering the pleural space
•Re-establishes intrapleural negative pressure
•Re-expands the lungs
From patient
Water seal
One bottle systemOne bottle system
Air out
For small pneumothoraxuse only !
Risk of progressive resis-tance building by haemothorax.
No control of the situationin the chest cavity.
Two bottle systemTwo bottle systemFrom patient
Collectionbottle
Water seal
Air outSeparation of water sealand collection in 2 bottles elliminates the risk ofprogressive resistance building.
No active suction co-nection recommended.Limited information aboutthe situation in the chestcavity
Three bottle systemThree bottle system
From patient
Collectionbottle
Water seal
Suction controlbottle
Active suction
Three bottle systemThree bottle system
• Separated collection, underwater seal and suction control bottle
• No risk of progressive resistance building
• Exact active suction control
• Limited information about the situation inside the chest cavity
Four bottle systemFour bottle system
Patient assesment bottle
Collectionbottle
Water sealbottle
Suction controlbottle
Active suction
From patient
Four bottle systemFour bottle system
Patient assesment bottle
Collectionbottle
Water sealbottle
Suction controlbottle
Active suction
From patient
Four bottle systemFour bottle system
• Separated collection, underwater seal, suction control and patient assesment bottles
• No risk of progressive resistance building
• Exact active suction control
• Exact information about the situation inside the chest cavity
Bottle systemsBottle systems
•Complicated to assemble and connect to patient•Problem to transport•Made from vulne- rable material•Difficult to monitor
IMPROVEMENTNEEDED
From bottles to CDUsFrom bottles to CDUs
PatientActivesuction
Suctioncontrolchamber
Underwater seal chamber
Collectionchamber
3Ch.CDU system
TYCO Healthcare offers complete line of the chest
drainage units
TYCO Healthcare offers complete line of the chest
drainage units
THORA SEAL I
• Analogy of the one bottle concept• For pneumothorax only• Compact, easy to use• Disposable, break resistant• for gravity drainage only• Self contained floor stand• Ready to use
THORA SEAL II
•Analogy of the two bottle concept•Separated underwater seal chamber and 2,6 litre collection chamber•Easy to read Hi/Low volume graduations (write on)•Integrated floor stand•Strand hanger•Clear PVC connection tubes with anti kink device
THORA SEAL III• Analogy of the 3 bottle concept
• Compact, break resistant
•Removable/Replacable collection chamber with: - Hi/Low volume graduations - White, write-on background
• Unique baffle system prevents fluids from spilling and mixing
•Automatic possitive pressure relief valve
•Build-in hanger, floor stand and tube anti-kink device
•Muffler in suction control
•Self-sealing Kraton patient tube
THORA SEAL III
Aqua Seal
• 3 bottle system concept• Compact, break resistant• Easy to install and use
• Collection chamber: - Paediatric and adult graduations - White, write on background - Kraton self-sealing patient tube - Croppable connector
Aqua Seal
• Underwater Seal Chamber:
- blue coloured water level - Patient assessment graduations - Syrringe for easy filling in - Automatic possitive pressure releif valve - Manual negative pressure relief valve - Water seal access port
Aqua Seal• Suction control chamber: - flow control valve on suction port - Suction control bypass adapter - Wide opening for easy filling in • Other: - Wide 90 degree rot. footstand - Steel hangers - Integrated handle - Setup instructions on unit - Double CSR warp
Aqua Seal
Aqua Seal
Sentinel Seal•Modified four bottle concept•Exclusive „dry“ suction control regulator•Quiet operation•Exclusive patient assesment chamber with blue coloured water level•Automatic possitive pressure releif valve•Filtered manual negative pressure relief valve•Easy to setup and use•Crystal clear, compact
Double SealFour bottle system concept
Collection chamber- 3 column chamber- Hi/low graduation for paediatric and adult use- White, write on background- self sealing collection tube
Underwater Seal chamber- blue coloured water level- patient and/or system air leak control
Double SealSuction control chamber- Bubbling suction controler- blue coloured water level- automatic possitive pressure relief valve
Patient assessment chamber- actual negative pressure readout- continuous monitoring of lung reexpansion process- possitive pressure relief- Automatic negative pressure relief
Patient Assessment - what is the CDU telling me
Tidaling* Bubbling**
Yes Yes
No No
No Yes
Yes No
Large pneumothorax or systemleak - lung still not re-expandedCheck for changesLung reexpansion (slide tidalingcan be observed). Check thecollection tube for kinkingConnection or system leakPinch off the catheter. If the samecheck all connections.Stiff lung desease or patient afterpneumonectomy
Thoracic catheters
•Made from thermosensitive PVC or clear silicone•Sentinel Line and Eye for X-ray possition verification•Smooth finish on tip and eyes•Integral bubble connector for easy connection•Rigid pack container
For open chest application (peroperative)
Trocar catheters
Thoracic catheter intimately seated on aluminium trocar rodTrocar caries the catheter with it as it penetrates the chest wall and enters pleural cavity Colour coded trocars for easy indentifiaction
For closed chest drainage
Safety Shield Trocar cathetersNEW !!!NEW !!!
....a safety trocar thoracic catheter which:• Minimizes the risk of inadverent lung puncture• Provides safe, quick access to the pleural space
Argyle
ThoracentesisExclusive Turkel Safety thoracic punture systemMinimal risk of lung punture and pneuomothorax
Safety canula - withdraws into the shaft during chestwall penetrationAutomaticaly extends when entering pleural spaceSafety color change indicator confirmes the position
Thoracentesis
Pateneted safety valve allows air and fluid to leavethe chest cavity, prevents atmospheric air to enter.
Soft and flexible polyurethane radiopaque catheterwith 1 cm graduations and multiple side holes