chest tubes

Question 1

purpose of CT?

Answer 1

restore the negative pressure of the pleural space by draining excess fluid/air

indications?
- pneumothorax
- hemothrorax
- hemopneumothorax
- pleural effusion
- emphysema (pus in pleural space)

Question 2

what are the 3 units of a chest drainage unit?

Answer 2

1) collection chamber
2) water seal chamber
3) suction chamber

Question 3

what does the collection chamber do?

Answer 3

collects liquid drainage up to 2000-2500ml

Question 4

what does the water seal chamber do? how does it work?

Answer 4

prevent environmental air from entering pleural space during CT therapy

tube is submerges under 2cm of sterile water and fnxs like a one way valve that allows air to only exit

the air that leaves the pleural space bubbles through water in the water seal chamber

water lvl fluctuates as pressure in space changes when pt breathes

continuous bubbling is bad

Question 5

what are the 2 types of suction?

Answer 5

1) water suction
2) dry suction

Question 6

what is water suction? how does it work?

Answer 6

regulates suction by amount of sterile water in chamber (md order)

Question 7

what is dry suction suction? how does it work?

Answer 7

regulated by dial

Question 8

what are interventions r/t the collection chamber?

Answer 8

1) measure the drainage q1-8h (document on CDU and chart)
2) change CDU when chamber is full
3) temp increase in drainage w position change
4) w time amount should decrease and become light
5) report: more than 70ml/h of bright red OR if color
goes from clear to red

Question 9

what are assessment r/t the water seal chamber?

Answer 9

1) keep and eye in water lvl
2) assess tidaling
- fluctuation correspond w resp
- if fluctuations stop = obstruction
3) assess bubbling, if no air bubbling = air leak or no
more air in pleural space

Question 10

what are the steps when changing CDU?

Answer 10

1) instruct pt to hold breath (valsalva manoeuvre)
2) clamp w padded forceps
3) aseptic technique -> dc old CDU and connect new
4) remove clamps
5) document

Question 11

when can the CT be removed?

Answer 11

• lung sounds indicate GAEB
• CXR shows lung rexpanded
• Drainage over last 24 = less than 50-100ml
• resps = normal
• fluctuation in eater seal stopped

Question 12

why you shouldn’t milk the tubing if it’s not draining?

Answer 12

can increase negative pressure in CT and do little to improve patency

Question 13

what happens if decreased/stopped drainage?

Answer 13

• asses pt: lungs (diminished breath sounds= blood build up)
• turn cough, deep breathe
• reposition

Question 14

if tube gets D/C by mistake?

Answer 14

• cough and exhale (prevent air from rushing in)
• apply occlusive petroleum dry gauze (3 sides)

Question 15

what if water seal damaged?

Answer 15

• change cdu
• place distal end in 250ml of NS