Caring Interventions

Question 1

What is the purpose of a chest tube?

Answer 1

to drain fluid, blood or air from the pleural space and to reestablish negative pressure in the lungs

Question 2

WHat are the 3 chambers in a chest tube and what are they used for

Answer 2

first chamber- drainage chamber
second chamber- water seal
third chamber- suction control

Question 3

How is a water seal chamber established? How does it work and how to keep it working?

Answer 3

By adding 2 cm of sterile saline to the chamber -amount can vary
allows air to exit and not renter
- Make sure chest tube is below patient and upright
- Monitor line for signs of evaporation

Question 4

How does a wet suction system work?

Answer 4

the water level controls the suction pressure (20mmHG) - attach to suction and gently bubbling begins in the suction chamber

Question 5

How does a dry suction system work?

Answer 5

a level of suction is prescribed and set on the regulator

Question 6

What is tidaling in the water seal of a chest tube mean? What if tidaling does not occur what does that indicate?

Answer 6

its the movement of fluid level with respirations
If tidaling stop that signals lung reexpansion or obstruction

Question 7

WHat does continuous bubbling mean in the water seal chamber mean? WHat should you normal see in this chamber?

Answer 7

Air leak
should normally just be intermittent bubbling

Question 8

What are some indications for a chest tube to be inserted?

Answer 8

Pneumothorax, hemothorax, post op chest drainage, pleural effusion and pulmonary emphysema

Question 9

A client who needs a chest tube how will they present ?

Answer 9

dyspnea
distended neck veins
chest pain
cough
absent or reduced breath sounds
asymmetrical chest wall motion

Question 10

What to consider before the procedure ?

Answer 10

verify the consent sign is formed
inform that breathing will improve
assess for allergies
assist into position( supine or semi fowlers)
prepare the drainage system
administer pain medication
prep the insertion site

Question 11

What to do after the procedure?

Answer 11

take VS- breath sounds O2 and respiratory effort every 4 hr
monitor chest tube placement and function
document drainage color and amount - hourly for 24h then every 8h
monitor tube for kinks
monitor insertion site for infection
obtain a chest xray to confirm placement

Question 12

WHat nursing actions should be done to help removal of a chest tube?

Answer 12

administer pain medications
instruct patient to bear down ( valsalva maneuver)
apply airtight petroleum jelly gauze
obtain chest x rays