Chest Tubes

Question 1

Does the pleural cavity have positive or negative pressure?

Answer 1

negative

Question 2

Does the lung and atmosphere pressure have positive or negative pressure?

Answer 2

positive

Question 3

What direction do the lungs recoil?

Answer 3

inward

Question 4

What direction does the chest recoil?

Answer 4

outward

Question 5

What is an iatrogenic pneumothorax?

Answer 5

collapsed lung r/t medical procedure (i.e. CVC insertion, lung biopsy, pacemaker insertion, CPR, or barotrauma r/t mechanical ventilation)

Question 6

What causes a non-iatrogenic pneumothorax?

Answer 6

penetrating/blunt trauma

Question 7

Why does a tension pneumothorax occur?

Answer 7

air gets trapped in the pleural space under positive pressure, and this compresses the lungs

Question 8

Why does a tension pneumothorax decrease venous return to the heart?

Answer 8

the lungs are compressed

Question 9

If someone presents with distended neck veins, tracheal deviation, and hemodynamic instability, what may be happening with the patient?

Answer 9

tension pneumothorax

Question 10

What is pleural effusion?

Answer 10

an abnormal collection of fluid in the pleural space

Question 11

What is empyema?

Answer 11

collection of pus in the pleural cavity

Question 12

Why would a patient require a chest tube?

Answer 12

to restore negative pressure in the pleural space by removing blood, fluid, or air from the pleural space and it may be placed after heart or lung surgery

Question 13

Where is a chest tube typically placed?

Answer 13

the 2nd ICS

Question 14

Why would a chest tube be inserted into the 5th ICS?

Answer 14

to treat a hemothorax/pleural effusion, or empyema

Question 15

Why are chest tubes inserted into the 5th ICS for a hemothorax, pleural effusion, or empyema?

Answer 15

in order to create negative pressure to allow reexpansion of the lungs

Question 16

Why would a mediastinal chest tube be placed?

Answer 16

to drain away blood from the surgical site after open heart surgery

Question 17

Where is a mediastinal chest tube placed?

Answer 17

pericardial area

Question 18

What are some complications of a chest tube placement?

Answer 18

bleeding, infection, pain, pneumothorax

Question 19

What is the water seal on a wet atrium system used for?

Answer 19

to prevent air from going back into the lungs after exhaling

Question 20

What is the most commonly ordered suction for a dry atrium system?

Answer 20

-20

Question 21

What happens when the ball in the “b” chamber moves up?

Answer 21

the patient has inhaled

Question 22

If a patient exhales, how will the ball in the tidaling chamber move?

Answer 22

the ball will fall

Question 23

What is a direct measure of lung expansion when looking at the atrium system connected to the chest tube?

Answer 23

tidaling in the “b” chamber

Question 24

If there is tidaling with bubbles in the water seal, what is possibly happening?

Answer 24

air leak

Question 25

If there is intermittent bubbling in the water seal chamber, what may be occurring?

Answer 25

respirations when the lung has not fully expanded

Question 26

If there is no bubbling in the water seal chamber, what may be occurring?

Answer 26

the lung is fully expanded or the tube is occluded

Question 27

How can a leak be located?

Answer 27

manually clamping the tube starting at the insertion site and then proceed down the tube every 6-12 inches

Question 28

How long can a tube be clamped when assessing for a leak?

Answer 28

no more than 10 seconds

Question 29

What should be assessed in the atrium when doing a chest tube assessment?

Answer 29

suction, water leak, water seal fluid level, drainage, and any cracks/broken pieces

Question 30

What is a dependent loop?

Answer 30

Tubing that is lower than the patient in one area, and then goes back up to patient level

Question 31

What does fluid typically look like initially for a CT?

Answer 31

sanguineous

Question 32

How much blood is typically seen in the drainage of a CT for a pneumothorax?

Answer 32

minimal if any

Question 33

What kind of fluid will drain from a CT placed for a pleural effusion?

Answer 33

clear/yellowish fluid

Question 34

What gauge needle should be used to get a CT sample?

Answer 34

20 gauge

Question 35

Why can you get a sample from any part of the chest tube?

Answer 35

the tubing is self-sealing

Question 36

Why should CTs not be stripped?

Answer 36

it causes negative pressure to build in the intrathoracic cavity

Question 37

If a patient needs to be disconnected from suction, what does the nurse need?

Answer 37

an order

Question 38

If a patient is not allowed to be off of suction during transport, what can be used?

Answer 38

portable suction

Question 39

If a chest tube comes out, what do you do?

Answer 39

Place a Vaseline/4x4 gauze over the hole and tape it on three sides

Question 40

If there is a disconnection between the CT and the atrium tubing, what should be done?

Answer 40

the end of the tubing should be placed in 1-2 inches of sterile water

Question 41

If there is an obstruction in the CT what should be done?

Answer 41

milk tube gently and call the MD prn

Question 42

Why should gauze only be taped on three sides if a chest tube comes out?

Answer 42

to maintain pleural pressure and allow air to escape

Question 43

When can a nurse discontinue a chest tube? When can they not?

Answer 43

if a nurse is specially trained, they can remove pericardial chest tube, but nurses can never remove a chest tube that terminates in the pleural space

Question 44

How should the patient be monitored after a CT removal?

Answer 44

Q15 min for 1 hour

Question 45

What should the patient be monitored for following a CT removal?

Answer 45

SOB, CP, change in VS, restlessness (sign of dyspnea), persistent bleeding from CT site, any sign of reoccurring pneumothorax