Chest and drainage tubes Flashcards
purpose of chest tube
used to
reestablish intrapleural pressure,
re-expand the lung
improve oxygenation
What do CT drain
- hemothorax: blood
- pneumothorax:air
- pleural effusion: fluid
- empyema: pus
process of inspiration and expiration
Thelungs aresuspended in the thoracic cavity which is normally at a slightnegative pressure. When the diaphragm is lowered, thatpressurebecomes morenegativeand thelungsexpand into the cavity. Air from the atmosphere moves into the resulting partialvacuumandinflatesthe alveoli.
chest tube placement
- consent
- placement
- sutured in place
- airtight dressings/vasoline gauze
- attached to closed drainage system (may or may not be used with suction)
- CXR to confirm placement
disposable 3 chamber system
- drainage collecting
- water seal chamber
- suction chamber
to do assess for when patient has a 3 chamber system
-feel around the site of insertion for crepitus (air in the skin)
what should be at bedside if the chest tube disconnects?
keep a bottle fo sterile saline at the bedside. If chest tube disconnects from drainage unit, submerge the end in water. This is done instead of clamping to prevent tension pneumothorax
chest drainage system: collection chamber
-purpose?, documentation? what to report?
- acts as reservoir for fluid and air draining from chest tube.
- keep upright
- mark level q1 for 24hrs then q8 hours: do not empty
- report excessive drainage greater than 100mL/hour
- note consistency of drainage, purulent, vs bright red
chest drainage system: water seal chamber
- has one way valve/ water seal that prevent air form moving back into the chest with inspiration.
- fill to 2 cm of H2O
- tidals with respiration: cessation of tidaling
- continuous bubbling indicates air leak: assess system
- air leak monitor: indicates degree of air leak if present
tidal and tidaling
increase in water level with inspiration and return to the baseline (2cm) during exaltation.
what does cessation of tidaling mean?
can mean that lung has re-expanded or and obstruction in the system
chest drainage system: suction chamber
Why is suction applied? what does suction control chamber do? how do you know if it is working properly? what to set suction to?
- suction may be applied to create negative pressure and promote drainage of fluid and removal of air
- suction control chamber: regulates the amount go negative pressure applied to the chest. amount of suction determined by water level (20cm)
- when suction is on: bubbling appears in the suction chamber
- dry: set to -20cm using dial
- wet: degree of suction is set by water level (20cm H2O)
care considerations with chest tube
-semi fowlers position
-coughing and deep breathing q2: use incentive spirometer
assess:
- subcutaneous emphysema
-respiratory status
-drainage
-occlusive dressing
-all connections taped
-tubing free of kinks
-site for s/s infection
subcutaneous emphysema
-has a characterizes crackling feel to the touch
feeling is called subcutaneous crepitation
risk fir tension pneumothorax
-symptoms? what not to do?
- never clamp tubing unless necessary
- do not strip or milk tubing
symptoms: - tracheal deviation
- absent breath sounds on 1 side
- JVD
- respiratory distress
- asymmetrical lung expansion
- cyanosis
