Chest tube

Question 1

All chest tubes go into___

Answer 1

pleural space

Question 2

what has happened to make the patient need a chest tube?

Answer 2

the lung has collapsed

Question 3

once the chest tube is inserted, what kind of dressing will the doc put on it?

Answer 3

an occlusive sterile dressing at the insertion site

Question 4

what is the purpose of the water-seal chamber?

Answer 4

to promote 1 way flow out of the pleural space. (because we don’t want that stuff going back in)

Question 5

Do we want to see fluctuations in the water seal tube/chamber?

what does fluctuation mean?

Answer 5

yes!

• that you have a good connection.

Question 6

when do we want to see fluctuations in the water seal chamber?

Answer 6

with respirations

Question 7

How often should this patient get chest x-rays done?

Answer 7

re-expansion

Question 8

expect what 3 things to have happened if fluctuations stop:

Answer 8

1- the lung has re-expanded

2- there’s a kink or clot in the tubing

3- if suction is not working properly

Question 9

why is it sooo important to keep the pleur-Evac below the level of the chest?

Answer 9

because if you lift it up, the drainage will go back into the pleural space (we want to promote a 1 way flow)

Question 10

when the chest tube is disconnected, what are you scared of?

what do you do if the tubing becomes disconnected?

Answer 10

• air from outside will get into the lungs and collapse it
• pick up the dirty connector and reconnect the dirty connector. (you gotta whatever you can to re-establish water seal because this patient might die)

Question 11

what do you do if the bottles/chambers and the water seal is lost?… what should you be affraid of?

Answer 11

• afraid that air will get into the lungs and collapse it
• you have to take the tube and put it in the patient’s ice pitcher cup (that has water in it)… sterile water would be ideal, but it’s not always available. and it has to be bellow chest level.

do whatever you can to reestablish water seal

Question 12

if the chest tube is connected to suction, what is expected?

Answer 12

gentle continuous bubbling is expected

Question 13

you have a patient who has a pleur-evac, you walk into the room and you see vigorous/excessive bubbling in the water seal chamber. what should you suspect?

excessive bubbling =___. what must we do? do we start at the patient or the tubing?

Answer 13

there’s an air leak in the system

• air leak in the system; find the location of the air leak and tape it up.
  always start at the patient. (usually at the connecting site)

Question 14

if a patient with a pneumothorax has a chest tube, what would you expect to see in the system?

Answer 14

intermitten bubbling

Question 15

with any chest tube patient, for what 2 reasons would you call the doctor?

Answer 15

1- when the drainage is > 100 ml/hr

2- When you see bright red drainage

Question 16

DO NOT___ or ___ the chest tube without an MD order. why?

Answer 16

milk or strip

when you’re milking it (pinching) the tube, it can cause a lot of negative pressure which can damage the lung.

Question 17

NEVER ___ a chest tube without an MD order. why?

what happens when you see your chest tube patient has a media stinal shift?

Answer 17

clamp (even for a few seconds); it can lead to a tension pneumothorax

• they now have a tension pneumothorax (that can kill em fast)

Question 18

because we usually have an occlusive dressing over the site of the chest tube, and you’re trying to change the dressing, but it gets stuck over the tube. what do you do if you’re pulling hard on it and you ACCIDENTLY PULL OUT THE CHEST TUBE?

Answer 18

• Normally, we would want to use a sterile vaseline gauze taped on 3 sides, but someone took it.
• we don’t want air to get into the lungs, so WE PUT OUR GLOVED HAND OVER IT.

Question 19

when the doctor removes the chest tube, the patient will need to _____

or , the can do the___ manuever, and an occlusive petroleum dressing with 4 X4 will be placed over the site.

Answer 19

• take a deep breath and hold.

- valsalva