UNIT 2: RESPIRATORY DISTRESS
81
Skill Unit
Detecting a Pneumothorax
These skill units will teach you how to detect a pneumothorax. Two techniques will be cov-
ered: transillumination and chest x-ray. Not everyone will be required to learn how to transil-
luminate a baby’s chest with a fiber-optic light or to interpret chest x-rays. However, everyone
should read this unit and attend a skill session to learn equipment, sequence of steps, and cor-
rect positioning of a baby to assist with these skills.
Note: The illustrations for these separate skill units are not meant to be linked to each other,
although the baby appears similar throughout. The transillumination and chest tube
insertion skills show left pneumothoraces, while a right pneumothorax is illustrated in
the needle aspiration skill, and x-rays of both left and right pneumothoraces are shown.
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 skill steps correctly:
Transillumination
1. Position the “baby.”
2. Set transillumination light to proper setting(s).
3. Darken room.
4. Maintain the “baby’s” therapy: oxygen delivery, thermal environment, intravenous (IV)
infusions, etc.
5. Position tip of fiber-optic light on “baby’s” chest.
Mid-axillary area
Mid-clavicular area
Chest x-ray: Anterior-posterior view
1. Place the “baby” in a supine position
In an incubator
Under a radiant warmer
2. Maintain the “baby’s” therapy: oxygen delivery, thermal environment, IV infusions, etc.
3. Reposition tubes and/or wires, as necessary and appropriate.
4. Shield the “baby’s” genitalia and caution others within range of x-ray beam to move or put
on a lead apron.
5. Restrain the “baby,” if necessary.
Chest x-ray: Lateral decubitus view
1. Place the “baby” in a lateral decubitus position (with side under suspicion up)
In an incubator
Under a radiant warmer
2. Maintain the “baby’s” therapy: oxygen delivery, thermal environment, IV infusions, etc.
3. Reposition tubes and/or wires, as necessary and appropriate.
4. Shield the “baby’s” genitalia and caution others within range of x-ray beam to move or put
on a lead apron.
5. Restrain the “baby,” if necessary.
6. Hold x-ray plate in proper position. A lead apron should be worn by the individual holding
the plate in position.
Note: While useful results depend on carrying out these skills correctly, interpretation of findings
is not included in these checklists. Physicians, and selected nurses, may be asked to partici-
pate in a workshop for interpretation of transillumination and chest x-ray findings.
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