Chest Tubes Flashcards
What is the purpose of a pleural chest tube?
Re-establish negative pressure, drain the pleural space, and allow for lung expansion.
Describe the process of a chest tube insertion.
- Pre-medicate when possible (painful procedure).
- Patient’s arm raised over head to expose midaxillary area.
- Elevate HOB; helps to lower the diaphragm.
- Provider cleanses w/ antiseptic.
- Locally anesthetized & small incision made.
- Chest tube is inserted & sutured in by provider.
- Wound covered w/ occlusive dressing.
- Tube placement is confirmed by chest x-ray.
What is the purpose of putting petroleum gauze around the chest tube exit site before adding dressing?
To help seal the site, avoiding atmospheric air from entering through the exit site.
What are 3 compartments of a chest tube drainage system?
Collection chamber: receives fluid & air from pleural cavity.
Water seal chamber: contains about 2 cm of water - which acts as a one-way valve. Incoming air enters from the collection chamber & bubbles up through the water. The water prevents the back flow of air into the patient.
Suction chamber: applies suction to the chest drainage system. Dry suction is most common.
How is the amount of suctioned determined when using a setup with dry suction?
By turning the dial on the CT device to the ordered amount.
What is the typical amount of chest tube suction applied?
-20 cm H2O
Is intermittent bubbling with exhaling, coughing or sneezing - an expected finding with a patient with a chest tube?
Yes, as long as there is air in the pleural space (as in the case with a collapsed lung; whether intentional w/ surgery or unintended such as a MVC).
Define “tidaling” with a chest tube.
Tidaling is when there is normal fluctuation with the water-seal chamber. It goes up and down with breathing
What causes tidaling, is it normal, and are there times when there is no tidaling?
Changes intrapleural pressure with breathing. And yes, it is normal.
If it stops suddenly, could mean tube is occluded.
Tidaling gradually slows/eventually stops - as the lung re-expands.
If the chest tube is hooked to suction, there will be no tidaling. It only happens with UWS.
What is a flutter valve (heimlich valve)?
Used to remove air from pleural space (for small to moderate pneumothorax).
Allows for mobility; can go home with them.
Must have a vent (just like a chest tube) for the air to escape; has one way valve (just like a chest tube).
What is subcutaneous emphysema?
Atmospheric air leaking into subq tissue
What to do if a chest tube becomes disconnected?
Immediate priority = reestablish water-seal system; take exposed end of tube and immerse in sterile water or saline until new system can be set up. Do NOT clamp tube.
What is the danger of clamping a chest tube?
The dange of rapid accumulation fo air in pleural space (that can no longer escape, due to clamping) can cause a tension pneumothorax.
When are the only times it is ok to “momentarily” clamp a chest tube?
- When you are checking for air leaks.
- When changing out the drainage set up.
What do you do if you see constantly bubbling in the water seal chamber?
Momentarily clamp the chest tube at the exit site.
1.** If the bubbling continues**, the “problem” is in the chest tube set up (distal to where you are clamping). Next best nursing action = replace the drainage system.
2. If the bubbling stops, the “problem” inside the patient (proximal to where you are clamping). Next best nursing action = notify HCP. (This is assuming you have already ensured the exit site has a secure petroleum gauze intact w/ secure dressing.)
