Chest Tube Drainage System

Question 1

Pneumothorax treatment

Answer 1

20% pneumothorax = thoracentesis, chest tube placement

Question 2

Nursing responsibility

Answer 2

• identify pts at risk
• assess decreased breath sounds on one side
• assess SOB
• note lack of chest movement on one side
• desaturation on pulse of

Question 3

Chest tube locations

Answer 3

Removal of air = high lateral chest

• removal of fluid = low lateral chest, low posterior chest
• removal of blood= low (under sternum) Anteriorly

Question 4

The drainage system

Answer 4

• three bottle system
• pleur-evac system-3 chambers
• waterless drainage system
• all contain:
• drainage chamber
• water-seal chamber
• suction chamber

Question 5

Chest tube sizes

Answer 5

8-12FR = infants, young children 
16-20Fr = children, young adults 
28-32FR = most popular adult size
36-40FR = large adult sizes

Question 6

Chest tube insertion

Answer 6

• incision made at insertion site
• puncture into the pleural cavity
• chest tube inserted
• placed to pleural drainage system
• sutured into place
• drainage system hung below chest level

Question 7

Once in place…

Answer 7

• secure the connections
• dress the site: cleanse site, Vaseline, occlusive dressing (change Q8hrs), date, time, initials, usually changed daily
• place below the chest of the pt
• place to suction as indicated: slow, soft bubbling

Question 8

Pt assessment

Answer 8

• document procedure:site, location, tube size
• assess immediately after insertion: respiratory status:- breath sounds, respiratory rate/pattern, SQ emphysema, pain, infection
• done Q shift and prn

Question 9

Daily assessment of the drainage system

Answer 9

S-site: dressing, drainage
T-tube: taped connections, dependent loops?(NO)
O-output: record Q8hrs, document I&Os, excess(>100cc/hr), mediastinal should decrease over time, document any air leak
P-patient: tidaling in water seal chamber

Question 10

Trouble shooting: removal

Answer 10

• may clamp for several-24hrs

- chest X-Ray done

Question 11

Trouble shooting: transport

Answer 11

• maintain upright
• maintain below the heart
• order to remove from suction

Question 12

Trouble shooting: changing the system

Answer 12

• prepare new system (pleur-evac)
• clamp CT above connection
• remove old system and attach new system
• unclamp ASAP

Question 13

Only reason to clamp a CT

Answer 13

• changing a system
• assessing for an air leak
• assessing for pts tolerance for CT removal

Question 14

Trouble shooting: dislodgement

Answer 14

• any disconnection should be immediately reconnected
• MD should be notified
• if fully pulled out: -Vaseline to sight immediately
• occlusive dressing
• notify MD STAT
• prepare for STAT X-ray
• observe for S/S of pneumothorax : decreased O2 sats, SOB, inability to breath

Question 15

Indications

Answer 15

• closed pneumothorax
• blunt trauma closed pneumothorax
• tension pneumothorax
• open pneumothorax
• pleural effusion