ATI: Chapter 18 - Chest Tube Insertion and Monitoring Flashcards
Chest tubes are inserted into the _____ to drain fluid, blood, or air; reestablish a negative pressure; facilitate lung expansion; and restore normal intrapleural pressure.
pleural space
Chest tubes can be inserted in the emergency department, at the bedside or in the operating room through a _______ incision.
thoracotomy
A disposable three-chamber drainage system is most often used. First chamber: ________ collection. Second chamber: water seal. Third chamber: ______ control (can be wet or dry)
drainage
suction
______ are created by adding sterile fluid to a chamber up to the 2 cm line. While this is the minimum amount required for functioning, recommended amounts can vary by manufacturer. The ____ allows air to exit from the pleural space on exhalation and stops air from entering with inhalation.
water seals
water seal
To maintain the water seal, keep the chamber ______ and ______ the chest tube insertion site at all times. Routinely monitor the water level due to the possibility of evaporation. Add fluid as needed to maintain the manufacturer’s recommended water seal level.
upright
below
Wet suction: The height of the sterile fluid in the suction control chamber determines the amount of suction transmitted to the pleural space. A suction pressure of ____ cm H20 is commonly prescribed. The prescribed amount of suction is applied by setting the regulator on the chest tube drainage device. The application of suction results in continuous bubbling in the suction chamber. Monitor the _______ and add fluid as needed to maintain the prescribed level of suctioning.
-20
fluid level
Dry suction: When a dry suction control device is used, the provider prescribes a level of suction for the device, typically ____ cm H20. When connected to wall suction, the regulator on the chest tube drainage system is set to the manufacturer’s recommendation.
-20
_______ (movement of the fluid level with respiration) is expected in the water seal chamber. With spontaneous respiration, the fluid level will rise with inspiration (increase in negative pressure in lung) and will fall with expiration. With positive-pressure mechanical ventilation, the fluid level will rise with expiration and ____ with inspiration.
Tidaling
fall
Cessation of tidaling in the water seal chamber signals _______ or an obstruction within the system.
lung re-expansion
Continuous bubbling in the water seal chamber indicates and ______ in the system.
air leak
Indications for chest tube insertion
pneumothorax hemothorax postoperative chest drainage pleural effusion pulmonary empyema
______ is a partial to complete collapse of the lung due to accumulation of air in the pleural space.
pneumothorax
______ partial to complete collapse of the lung due to accumulation of blood in the pleural space.
hemothorax
_______ as a result of thoracotomy or open-heart surgery.
postoperative chest drainage
_______ is the abnormal accumulation of fluid in the pleural space.
pleural effusion
_______ is the accumulation of pus in the pleural space due to pulmonary infection, lung abscess, or infected pleural effusion.
pulmonary empyema
A chest tube is indicated when a client presents with…
dyspnea
distended neck veins
hemodynamic instability
pleuritic chest pain
cough
absent or reduced breath sounds on the affected side
hyperresonance on percussion of affected side (pneumothorax)
Dullness or flatness on percussion of the affected side (hemothroax, pleural effusion)
Asymmetrical chest wall motion
Prior to the chest tube verify that the consent form is ____.
signed
Reinforce client teaching. ______ will improve when the chest tube is in place.
Breathing
Prior to placement of a chest tube, assess for ______ to local anesthetics.
allergies
Assist the client into the desired position (_______ or _______) prior to a thoracentesis.
supine or semi folwers
Prepare the _______ system prior to the chest tube insertion per the facility’s protocol. (fill the water seal chamber.)
chest drainage
Administer pain and ______ mes as prescribed prior to the chest tube insertion.
sedation
Prep the insertion site with ______ or other facility-approved agent.
povidone-iodine
Assist the provider with insertion of the chest tube, application of a ______ to the insertion site, and set-up of the drainage system.
dressing
Place the chest tube drainage system below the client’s chest level with the tubing coiled on the _____. Ensure that the tubing from the bed to the drainage system is straight to promote drainage via _______.
bed
gravity
The nurse should continually monitor vital signs and response to the ____.
procedures
Postprocedure assess vs, breath sounds, SaO2, color and respiratory effort as indicated by the status of the client and at least every ___ hours.
4 hours
Encourage coughing and deep breathing every ____ hours.
2 hours
Keep the drainage system below the client’s chest level including during ______.
ambulation.
Monitor chest tube placement and function check the water seal level every ______ and add fluid as needed. The fluid level should fluctuate with respiratory effort.
2 hours,
Monitor chest tube placement and function, document the amount and color of drainage hourly for the first 24 hours and then at least every _______ hours.
8
Monitor chest tube placement and function, mark the date, hour, and ______ level on the container at the end of each shift. Report excessive drainage, greater than ______ or drainage that is cloudy or red to the provider.
drainage
70 mL/hr
Drainage often ____ with position change or coughing.
increases
Monitor the fluid in the suction _________, and maintain the prescribed fluid level.
control chamber,
Ensure the regulator dial on the ____ suction device is at the prescribed fluid level.
dry
Check for expected findings of tidaling in the water seal chamber and continuous bubbling only in the _____.
suction chamber
Routinely monitor tubing for kinks, ______, or loose connections.
occlusions
Monitor the chest tube insertion site for _____, pain, infection, and crepitus (air leakage in subcutaneous tissue.
redness
Tape all connections between the chest tube and the _______.
chest tube drainage system.
Position the client in the ______ to _____ position to promote optimal lung expansion and drainage of fluid from the lungs.
semi to high fowlers
Administer pain medications as prescribed after the placement of a _____.
chest tube.
Keep two enclosed _____, sterile water, and an occlusive dressing located at the bedside at all times.
hemostats
Obtain a ______ to verify the chest tube placement.
x ray
Due to the risk of causing a tension pneumothorax, chest tubes are clamped only when prescribed in specific circumstances, such as in the case of an air leak, during _______ change, accidental disconnection of tubing, or damage to the drainage system.
drainage system change
Do not strip or ______ tubing; only perform this action when prescribed. Stripping creates a high negative pressure and can damage lung tissue.
milk
_____ are a complication associated with chest tubes. It can result if a connection is not taped securely.
air leaks
Monitor the water seal chamber for _____ which is a finding of air leaks. Check all the connections and notify the provider if an air leak is noted.
continuous bubbling
If prescribed, gently apply a padded clamp to determine the ______ of the air leak. Remove the clamp immediately following assessment.
location
Accidental disconnection, system breakage, or removal are complications that can occur at anytime. If the tubing separates, instruct the client to _____ as much as possible and to cough to remove as much air as possible from the pleural space.
exhale
If the chest tube drainage system is compromised, immerse the end of the chest tube in _____ to restore the water seal.
sterile water
If a chest tube is accidentally removed, dress the area with dry, _______.
sterile gauze
Sucking chest wounds, prolonged clamping of the tubing, kinks or obstruction in the tubing, or mechanical ventilation with high levels of positive end expiratory pressure (PEEP) can cause a ________.
tension pneumothorax
Assessment findings include tracheal deviation, absent breath sounds on one side, distended neck veins, respiratory distress, asymmetry of the chest, and _____.
cyanosis.
Provide pain meds _____ minutes before removing chest tubes.
30 minutes.
Assist the provider with sutures and chest tube ____.
removal
Instruct the client to take a deep breath, exhale and _______ or to take a deep breath and hold it ( increases intrathoracic pressure and reduces risk of air emboli) during chest tube removal.
bear down (Valsalva maneuver)
Apply airtight sterile _______ dressing. Secure in place with a heavyweight stretch tape when you remove a chest tube.
petroleum jelly gauze
Obtain chest x rays as prescribed after chest tube removal. This is performed to verify continued resolution of the pneumothroax, hemothorax, or _____.
pleural effusion
Monitor for excessive wound drainage, signs of infection, or _________ after removing a chest tube removal.
recurrent pneumothorax
A nurse preparing to care for a client following chest tube placement. Which of the following items should be available in the client’s room? (Select all that apply)
A. Oxygen B. Sterile water C. Enclosed hemostat clamps D. Indwelling urinary catheter E. Occlusive dressing
A, B, C, E
Oxygen should be readily available in case the client develops respiratory distress following chest tube placement.
If the chest tube becomes disconnected, the end of the tubing should be placed in sterile water to restore the water seal
Hemostat clamps should be available for the nurse to use to check air leaks
Immediately place an occlusive dressing over the chest tube insertion site if becomes disconnected. This allows air to escape and reduces the risk for a tension pneumothorax
A nurse is caring for a client who has a chest tube and drainage system in place. The nurse observes that the client’s chest tube was accidentally removed. Which of the following actions should the nurse take first?
A. Place the tubing in sterile water to restore the water seal
B. Apply sterile gauze to the insertion site
C. Place tape around the insertion site
D. Assess the client’s respiratory status
B.
Using ABC priority framework, the application of a sterile gauze to the site should be the first action for the nurse to take. This allows the air to escape and reduces the risk of the tension pneumothorax
A nurse is assessing a client who has a chest tube and drainage system in place. Which of the following are expected findings? (Select all that apply)
A. Continuous bubbling in the water seal chamber
B. Gentle constant bubbling in the suction control chamber
C. Rise and fall in the level of water in the water seal chamber with inspiration
D. Exposed sutures without dressing
E. Drainage system upright at chest level
B, C
Gentle bubbling in the suction control chamber is an expected finding as air is being removed
A rise and fall of the fluid level in the water seal chamber upon inspiration and expiration indicate that the drainage system is functioning properly
A nurse is assisting a provider with the removal of a chest tube. Which of the following should the nurse instruct the client to do?
A. Lie on his left side
B. Use the incentive spirometer
C. Cough at regular intervals
D. Perform the Valsalva maneuver
D.
The client should be instructed to take a deep breath, exhale, and bear down as the chest tube is being removed. This increases intrathoracic pressure and reduces the risk of an air embolism
A nurse is planning care for a client following the insertion of a chest tube and drainage system. Which of the following should be included in the plan of care? (Select all that apply)
A. Encourage the client to cough every 2 hours
B Check for continuous bubbling in the suction chamber
C. Strip the drainage tubing every 4 hours
D. Clamp the tube once a day
E. Obtain a chest x ray
A, B, E
Cough every 2 hours to promote oxygenation and lung re-expansion
Check for continuous bubbling in the suction chamber to verify that suction is being maintained at an appropriate level
A chest x ray is obtained following the procedure to verify chest tube placement
