UNIT 2: RESPIRATORY DISTRESS
95
Skill Unit
treating a Pneumothorax
These skill units will teach you how to aspirate a pneumothorax in an emergency and how to place
and secure a chest tube. You also will learn how to maintain a chest tube and how to manage chest
tube suction. Not everyone will be required to learn how to relieve a pneumothorax. However,
everyone should read this unit and attend a skill practice session to learn the equipment and
sequence of steps so they can assist with needle aspiration and chest tube insertion.
It is critical that a “time-out” should be done prior to the procedure. The side of the pneumo-
thorax should be carefully confirmed by the operator and the individual assisting.
Everyone will be required to know how to maintain a chest tube safely.
Study these skill units, then attend a skill practice and demonstration session. To master the
skills, you will need to demonstrate each of the following steps correctly:
Needle aspiration
1. Collect the equipment and, wherever possible, connect the pieces together.
2. Position “baby.”
3. Restrain “baby,” if necessary.
4. Locate the second intercostal space at the mid-clavicular line. (See Figure 2.5.)
5. Cleanse this area.
Chest tube insertion: set up suction
1. Collect the equipment.
2. Assemble the pieces together.
Add water to the suction control and the water seal chambers or set up the preset valve
system.
Connect tubing to the universal adapter and to the suction source.
Chest tube insertion: prepare “baby”
1. Collect the equipment and prepare the “sterile” tray.
2. Position “baby.”
3. Continue therapy and maintain support systems: oxygen delivery, thermal environment,
intravenous (IV) infusions, etc.
4. Monitor “baby” with a cardiac monitor and an oximeter.
5. Reposition tubes and/or wires, as necessary and appropriate.
6. Locate the fourth or fifth intercostal space at the anterior-axillary area. (See Figure 2.5.)
7. Cleanse this area.
8. Tape the chest tube in place.
9. Turn on and adjust the suction.
10. Identify whether air is being evacuated from “baby’s” chest.
11. Demonstrate how to check for leaks in the system.
Note: While successful relief of a pneumothorax depends on carrying out these skills correctly,
actual insertion of a needle or chest tube is not included in these checklists. Physicians,
and selected nurses, may be asked to participate in a demonstration and practice work-
shop for needle aspiration and chest tube insertion on models.
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