Chest Tubes Flashcards
Does the pleural cavity have positive or negative pressure?
negative
Does the lung and atmosphere pressure have positive or negative pressure?
positive
What direction do the lungs recoil?
inward
What direction does the chest recoil?
outward
What is an iatrogenic pneumothorax?
collapsed lung r/t medical procedure (i.e. CVC insertion, lung biopsy, pacemaker insertion, CPR, or barotrauma r/t mechanical ventilation)
What causes a non-iatrogenic pneumothorax?
penetrating/blunt trauma
Why does a tension pneumothorax occur?
air gets trapped in the pleural space under positive pressure, and this compresses the lungs
Why does a tension pneumothorax decrease venous return to the heart?
the lungs are compressed
If someone presents with distended neck veins, tracheal deviation, and hemodynamic instability, what may be happening with the patient?
tension pneumothorax
What is pleural effusion?
an abnormal collection of fluid in the pleural space
What is empyema?
collection of pus in the pleural cavity
Why would a patient require a chest tube?
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
Where is a chest tube typically placed?
the 2nd ICS
Why would a chest tube be inserted into the 5th ICS?
to treat a hemothorax/pleural effusion, or empyema
Why are chest tubes inserted into the 5th ICS for a hemothorax, pleural effusion, or empyema?
in order to create negative pressure to allow reexpansion of the lungs
Why would a mediastinal chest tube be placed?
to drain away blood from the surgical site after open heart surgery
Where is a mediastinal chest tube placed?
pericardial area
What are some complications of a chest tube placement?
bleeding, infection, pain, pneumothorax
What is the water seal on a wet atrium system used for?
to prevent air from going back into the lungs after exhaling
What is the most commonly ordered suction for a dry atrium system?
-20
What happens when the ball in the “b” chamber moves up?
the patient has inhaled
If a patient exhales, how will the ball in the tidaling chamber move?
the ball will fall
What is a direct measure of lung expansion when looking at the atrium system connected to the chest tube?
tidaling in the “b” chamber
If there is tidaling with bubbles in the water seal, what is possibly happening?
air leak
If there is intermittent bubbling in the water seal chamber, what may be occurring?
respirations when the lung has not fully expanded
If there is no bubbling in the water seal chamber, what may be occurring?
the lung is fully expanded or the tube is occluded
How can a leak be located?
manually clamping the tube starting at the insertion site and then proceed down the tube every 6-12 inches
How long can a tube be clamped when assessing for a leak?
no more than 10 seconds
What should be assessed in the atrium when doing a chest tube assessment?
suction, water leak, water seal fluid level, drainage, and any cracks/broken pieces
What is a dependent loop?
Tubing that is lower than the patient in one area, and then goes back up to patient level
What does fluid typically look like initially for a CT?
sanguineous
How much blood is typically seen in the drainage of a CT for a pneumothorax?
minimal if any
What kind of fluid will drain from a CT placed for a pleural effusion?
clear/yellowish fluid
What gauge needle should be used to get a CT sample?
20 gauge
Why can you get a sample from any part of the chest tube?
the tubing is self-sealing
Why should CTs not be stripped?
it causes negative pressure to build in the intrathoracic cavity
If a patient needs to be disconnected from suction, what does the nurse need?
an order
If a patient is not allowed to be off of suction during transport, what can be used?
portable suction
If a chest tube comes out, what do you do?
Place a Vaseline/4x4 gauze over the hole and tape it on three sides
If there is a disconnection between the CT and the atrium tubing, what should be done?
the end of the tubing should be placed in 1-2 inches of sterile water
If there is an obstruction in the CT what should be done?
milk tube gently and call the MD prn
Why should gauze only be taped on three sides if a chest tube comes out?
to maintain pleural pressure and allow air to escape
When can a nurse discontinue a chest tube? When can they not?
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
How should the patient be monitored after a CT removal?
Q15 min for 1 hour
What should the patient be monitored for following a CT removal?
SOB, CP, change in VS, restlessness (sign of dyspnea), persistent bleeding from CT site, any sign of reoccurring pneumothorax
