Chest Drainage

Question 1

What is pleural Space?

Answer 1

Is the place between the ribs and the lungs

Question 2

Air or Fluid in the Pleural Space inhibits lung exantion and breathing?

Answer 2

Yes.

Question 3

Pleural Space must always contain positive or negative pressure?

Answer 3

Negative Pressure.

It will always fluctuate between -8 to -10 cm h2o, and during exhalation will be between -4 to -5 cm H2O

Question 4

How will be the difference between positive and negative pressure during inspiration and exhalation?

Answer 4

• Inspiration -8 to -10
• Expiration -4 to -5

Question 5

Indication for Chest Drainage Tubes?

Answer 5

• Surgery:
  
  • CABG
• Traumatic Chest Injuries:
  
  • Pnumothorax (Air between the lung and chest wall)
  • Hemothorax (is a type of pleural effusion in which blood accumulates in the pleural cavity)
• Pleural Effusion:
  
  • Build up fluid between the pleura
• Infection:
  
  • Emphysema

Question 6

If you want to drain Air from the pleural Space, where you place the dranage tube?

Answer 6

Must be higher on the second intercostal space in the midclavicular line.

Question 7

To drain Fluid from the Pleural Space, where you place you Chest drainage tube?

Answer 7

On the lower part in the 5^th - 7^th intercostal space in the midaxillary line.

Question 8

Termination of chest Tube

Answer 8

Assess for signs of re-expansion

• Minimal Drainage
• Minimal bubbling/ fluctuation in water seal chamber
• Chest X-Ray shows re-expansion
• MD may leave to gravity
• explain procedure to the patient
• Tube should be pulled at the end of inspiration
• some physian prefere coughing or holding breath
• Occlusive dressing

Question 9

What are the Chest Drainage System?

Answer 9

There are 3 systems

• 1 bottle system (just for drainage collection)
• 2 bottle system ( Air will come to second bottle)
• 3 bottle system (connected to suction)

Question 10

1 bottle system

Answer 10

• Collect any fluid drinage from the pleural space
• Operate by gravity (bottle must be below the patient)
• Marked to allow measurement of the quantity of pleural drainage

Question 11

2 bottle system

Answer 11

• Function as a one way valve alowing air to leave pleural space and preventing this to come back to the pleural space.
• In the presence of pneumothorax or air leak, bubbling wil be observed in the chamber.

Question 12

On spontaneously breathing patient, bubbling will be on Inspiration or exhalation?

Answer 12

On exhalation

Question 13

On positive pressure ventilation patient, bubbling will be on Inspiration or expiration?

Answer 13

Inspirtaion

Question 14

3 bottle system

Answer 14

• Regulate the amount of negative pressure apply above the water seal.
• Usful when large amount of fluids accumulates in the pleural space
• The water hieght level will detremine the amount of negative pressure

Question 15

wet suction system is like…?

Answer 15

3 bottle system

Question 16

Most collection system are consired full at

Answer 16

2500 cc or 2.5 L

Question 17

On a wet system, suction is controlled by:

Answer 17

Water level

Question 18

TRUE or FALSE

Wall suction is regulated until gentle bubbles appear

Answer 18

TRUE

Question 19

As the pleural space heal, you will see more or less bubbles

Answer 19

Less

Question 20

What would you do if chest drainage tube is accidentally disconnected?

Answer 20

• Reconnected ASAP
• Place end tube on a Sterile bottle of water
• Monitor the patient for signs of respiratory distress
• notify physician

Question 21

If you have to transport a patient, what do you do with chest tubes?

Answer 21

• Keep the rainage system lower than the patient chest
• May open suction end to air which equal the water seal
• Mayo clamps

Question 22

Accidental removal of chest tube

Answer 22

• Seal off insertion site
• notify physician
• Assess patient and prepare for reinsertion
• watch for tension pnemothorax