Chest Tube

Question 1

Indications for chest tube

Answer 1

Thoracic surgery
Penetrating chest wound
Unintentional catheter entry into intrapleural
Space during central line placement
Spontaneous bleb rupture
Malignancies causing impaired lymphatic drainage
Changes in colloidal osmotic pressure

Question 2

Pneumothorax

Answer 2

Air in pleural space

Question 3

Spontaneous pneumothorax

Answer 3

No apparent cause

Question 4

Tension pneumothorax

Answer 4

Rapid accumulation of air related to backing up of pressure

Question 5

Thoracotomy

Answer 5

Surgical opening of thorax

Question 6

Thoracentesis

Answer 6

Removal of pleural fluid with large bore needke

Question 7

Pleural effusion

Answer 7

Excess fluid into pleural space
X-ray- >300 mL

Question 8

Emypema

Answer 8

Pus in pleural space

Question 9

Chest tube insertion

Answer 9

Pre-medicate
Sterile
Painful
Supplies: Thoracotomy tray, chest tube, drainage system
Help maintain correct support
Psych support

Question 10

Chest tube atrium

Answer 10

Chest tube system
Suction
Under water seal-helps get air out
Collection chamber

Question 11

What should you do to indicate the initial drainage?

Answer 11

Time, date, initials

Question 12

Collection chamber

Answer 12

Accepts air or fluid from system through extension tubing
Directly attached to patient’s chest tube

Routinely check blood/fluid output, mark volume, date and time
Assess volume and appearance
Be aware of “expected” volume/appearance

Question 13

What is drainage from the chest tube documented as?

Answer 13

Output

Question 14

Water seal chamber

Answer 14

One way valve to prevent airflow back into patient

Assess for fluctuations, presence of abnormal bubbling

Question 15

Care prior to water seal chamber

Answer 15

Fill chamber with sterile water to 2 cm mark, refill PRN

Question 16

Tidaling

Answer 16

Abnormal fluctuations indicating an air leak, pressure in the pleural space

Question 17

Suction chamber

Answer 17

Regulates amount of negative suction pressure being exerted on intrapleural space

Question 18

What does the amount of suction depend on?

Answer 18

How much is dialed in by prescribed order

Question 19

What is a visual cue that the suction is working?

Answer 19

Color will light up on machine, visual alert

Question 20

Does an increase in vacuum suction = increased pressure in chest?

Answer 20

No, 1 tube to suction, 1 to chest

Question 21

If pneumothorax, what does bubbling indicate?

Answer 21

Normal and expected
Intermittent bubbling

Question 22

If constant bubbling?

Answer 22

Never normal
Assess for leak
Apply padded clamp

Question 23

If the bubbling stops with being clamped?

Answer 23

There is a leak at the exit or in the patient
Notify HCP

Question 24

If bubbling continues with being clamped?

Answer 24

Leak between clamp and drainage
Check connections or change out system

Question 25

When should a chest tube be clamped?

Answer 25

MOMENTARILY ONLY Trying to determine a leak Drainage system change Provider order-testing tolerance

Question 26

Air vent

Answer 26

NEVER BE OCCLUDED unless transport or disconnected Either open to air or connected to extension tubing -low wall suction

Question 27

Why should an air vent never be occluded?

Answer 27

Can cause a tension pneumothorax Backed up pressure trying to get out of pleural space with no where to go

Question 28

If the air vent is open to air-

Answer 28

Under water seal

Question 29

If the air vent is connected to extension tubing-

Answer 29

Suction HCP decision, dry suction, dialed in

Question 30

What will the HCP do if the under water seal is being tolerated over time?

Answer 30

Discontinue it

Question 31

Assessment of PT with chest tube

Answer 31

VS, resp-O2 sat and effort, ABGs Baseline lung auscultation, cxray Skin/mucous membrane color OOB-pulmonary toilet Elevate HOB-fowlers Keep collection tube BELOW heart Pain- ATC analgesics, pulmonary toilet ROM- affected shoulder Teach-don’t disconnect

Question 32

Insertion site of chest tube

Answer 32

Dressing-occlusive, dry, intact Palpate around dressing for subQ emphysema Mark edge of area with date and time, notify HCP if bigger Extension tubing-assure connections intact, avoid excess dependent looping

Question 33

Penumostat

Answer 33

For patient with pneumothorax and ready to go home but chest tube can’t come out Portable device

Question 34

PleurX

Answer 34

Drain/catheter for pleural effusions Covered with thin protective dressing while not being used For: persistent draining, lung cancer, recurrent pleural effusions, malignant ascites

Question 35

When does a patient use their pleurX?

Answer 35

When symptomatic at home 2-5 days between each use

Question 36

Advantages to pleuralX

Answer 36

Vacuum technology to collect fluid-no need for wall suction Can be inserted outpatient (endo/OR) Drained by line on collection bottle Less hospital trips, less respiratory complications Patient has control, safe, easy

Question 37

Chest tube removal roles of RN

Answer 37

Premedicate with analgesics, teach, support

Question 38

Chest tube removal role of HCP

Answer 38

Cut sutures, apply sterile petroleum gauze, instruct patient to take deep breath and bear down, removes tube

Question 39

What does a cxray confirm for chest tube removal?

Answer 39

Re-expansion of lung, drainage stopped