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NUR 334 > Chest Tube > Flashcards

Chest Tube Flashcards

1
Q

Indications for chest tube

A

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

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2
Q

Pneumothorax

A

Air in pleural space

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3
Q

Spontaneous pneumothorax

A

No apparent cause

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4
Q

Tension pneumothorax

A

Rapid accumulation of air related to backing up of pressure

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5
Q

Thoracotomy

A

Surgical opening of thorax

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6
Q

Thoracentesis

A

Removal of pleural fluid with large bore needke

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7
Q

Pleural effusion

A

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

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8
Q

Emypema

A

Pus in pleural space

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9
Q

Chest tube insertion

A

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

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10
Q

Chest tube atrium

A

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

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11
Q

What should you do to indicate the initial drainage?

A

Time, date, initials

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12
Q

Collection chamber

A

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

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13
Q

What is drainage from the chest tube documented as?

A

Output

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14
Q

Water seal chamber

A

One way valve to prevent airflow back into patient

Assess for fluctuations, presence of abnormal bubbling

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15
Q

Care prior to water seal chamber

A

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

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16
Q

Tidaling

A

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

17
Q

Suction chamber

A

Regulates amount of negative suction pressure being exerted on intrapleural space

18
Q

What does the amount of suction depend on?

A

How much is dialed in by prescribed order

19
Q

What is a visual cue that the suction is working?

A

Color will light up on machine, visual alert

20
Q

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

A

No, 1 tube to suction, 1 to chest

21
Q

If pneumothorax, what does bubbling indicate?

A

Normal and expected
Intermittent bubbling

22
Q

If constant bubbling?

A

Never normal
Assess for leak
Apply padded clamp

23
Q

If the bubbling stops with being clamped?

A

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

24
Q

If bubbling continues with being clamped?

A

Leak between clamp and drainage
Check connections or change out system

25
Q

When should a chest tube be clamped?

A

MOMENTARILY ONLY

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

26
Q

Air vent

A

NEVER BE OCCLUDED unless transport or disconnected

Either open to air or connected to extension tubing -low wall suction

27
Q

Why should an air vent never be occluded?

A

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

28
Q

If the air vent is open to air-

A

Under water seal

29
Q

If the air vent is connected to extension tubing-

A

Suction

HCP decision, dry suction, dialed in

30
Q

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

A

Discontinue it

31
Q

Assessment of PT with chest tube

A

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

32
Q

Insertion site of chest tube

A

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

33
Q

Penumostat

A

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

34
Q

PleurX

A

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

35
Q

When does a patient use their pleurX?

A

When symptomatic at home
2-5 days between each use

36
Q

Advantages to pleuralX

A

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

37
Q

Chest tube removal roles of RN

A

Premedicate with analgesics, teach, support

38
Q

Chest tube removal role of HCP

A

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

39
Q

What does a cxray confirm for chest tube removal?

A

Re-expansion of lung, drainage stopped

NUR 334 (4 decks)

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