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PneumothoraxHemothorax
Orientation 2003
Signs & Symptoms
Increased oxygen support Poor gases Dyspnea - labored breathing Diminished or no breath sounds Crepitus in upper or lower lung fields Apnea, bradycardia Low or falling saturation
TREATMENT
May resolve without treatment if asymptomatic
100 % Oxygen by head hood (Nitrogen washout)
Thoracentisis (needle aspiration)
Placement of thoracotomy or chest tube
Head Hood - 100 % Oxygen
Used with asymptomatic or non ventilated infants.
Helps in the absorption of the air by the pleural capillaries.
This treatment is not recommended in preterm infant due to oxtocity.
Thoracotomy
Placement of tube in the chest cavity to a drainage system
Water seal system (Pleur-vac, Atrium, water bottle set up, or Thoraseal)
Non-water seal system (Thoraklex)
Continuous negative pressure of 10 - 20 cm H20
THORACENTISIS
Removal of air by needle aspiration
Performed at the bedside by MD
May be before a thoracotomy tube is placed
May be done more than once
Assisting w/thoracentisis
Obtain the correct equipment (see handout) MD may ask you to pull off air while they
stabilize the needle placement– gently turn stopcock off to atmosphere and open to infant and
syringe
– gently pull fluid/air into syringe
– turn stopcock off to infant and open to atmosphere and syringe
– expel air/fluid with caution and appropriately
– document amount of fluid/air removed, status of infant
DOCUMENTATION
events leading to detection of air leak how the air leak was detected who performed the needle aspiration & what was aspirated amount color and consistency of aspiration chest tube placement, size, type type of drainage system and suction pressure presence of bubbling as well as pattern in drainage system
indicate if air leak is present use of sedation/anesthetics patient’s tolerance and comfort appearance of CT site and dressing Breath sounds and respiratory effort Any resuscitation efforts