Chest Tubes

Question 1

Chest tubes are inserted into…

Answer 1

The pleural space

Question 2

What is the pleural space?

Answer 2

It is the “potential” space between the parietal and visceral pleural

Question 3

A breach in the pleural integrity allows what to enter the pleural space?

Answer 3

Air or fluid

Question 4

Why is air/fluid in the pleural space a negative thing?

Answer 4

This condition prevents lung expansion and rapidly progresses to respiratory insufficiency, cardiovascular collapse, and ultimately death if unrecognized and untreated.

Question 5

What is a tension pneumothorax?

Answer 5

A tension pneumothorax is a life-threatening condition that develops when air is trapped in the pleural cavity under positive pressure, displacing mediastinal structures and compromising cardiopulmonary function.

Question 6

What is the immediate tx for a tension pneumothorax?

Answer 6

Thoracentesis to relieve immediate situation followed by chest tube insertion

Question 7

True or False

Chest tube insertion is always done in the Operating room.

Answer 7

• False
• Pending the situation, it is performed bedside, in the OR, or a interventional radiology suite

Question 8

If possible, what must be obtained prior to chest tube insertion?

Answer 8

CONSENT!

Question 9

What is the contraindication for the use of a sedative or analgesic agent prior to chest tube insertion?

Answer 9

Not to be used for those WITH artificial airways

Question 10

After chest-tube insertion, the patient may lose ____ milliliters of blood or transudate, potentially leading to _____.

Answer 10

• several hundred
• hypotension

Question 11

What should be done if there is an air leak at the chest tube insertion site?

Answer 11

Notify HCP immediately!

Question 12

True or False

Its ok to milk, strip or clamp the tube while providing care.

Answer 12

• FALSE
• Its never ok to do any of those things!

Question 13

What is a Hemopneumothroax?

Answer 13

A pneumothorax caused by blood in the pleural space rather than air

Question 14

What must be done to restore a PT w/ a chest tube due to pneumothorax to normal function?

Answer 14

all air and fluid must be removed, and the source of an air leak must be closed.

Question 15

True or False

Positive pressure outside the lung keeps the lung in a fully expanded position.

Answer 15

• False
• Negative pressure would do that

Question 16

Upon assessment of a PT with SOB, you notice there is a deviation of the trachea to the left. What is the immediate thought as to reason?

Answer 16

Pressure from a pneumothorax of the right lung

Question 17

What is a Thoracostomy?

Answer 17

A procedure to make an opening in the chest wall to insert a chest tube

Question 18

Intermittent bubbling in the water seal chamber upon expiration indicates…

Answer 18

A leak

Question 19

Continuous bubbling in the water seal chamber indicates…

Answer 19

A large leak between the drain and PT

Question 20

If a water seal leak is present, what is the Nurse’s course of action?

Answer 20

• Check drain for disconnection, dislodgement and loose connection, and assess patient condition.
• Notify medical staff immediately if problem cannot be remedied.
• Document on Fluid Balance Chart

Question 21

If the patient needs to be transferred to another department or is ambulant, the suction should be…

Answer 21

disconnected and left open to air.

Question 22

Why do we not clamp a chest tube?

Answer 22

It may cause a pneumothorax

Question 23

For treatment of pleural-space disruptions, chest-tube therapy should focus on what three primary objectives?

Answer 23

• Removing air and fluid as promptly as possible
• Preventing drained air and fluid from returning to the pleural space
• Restoring negative pressure within the pleural space to re-expand the lung.