Chest Tubes

Question 1

Indications for a chest tube

Answer 1

Closed pneumothroax
Tension pneumothorax
Open pneumothorax
Pleural effusion?

Question 2

Pneumothorax treatment:

<20% pneumothrax

Answer 2

Bed rest

Limited physical activity

Question 3

Pneumothrax treatment:

>20% pneumothorax

Answer 3

Thoracentresis or insertion of a chest tube attatched to an underwater seal

Question 4

Nursing responsibilty with chest tubes

Answer 4

Identify clients at risk
Listen to bilateral breath sounds***
Assess decreased breath sounds on one side
Assess SOB
Note lack of chest movement on effected side

Question 5

The drainage system of chest tubes

Answer 5

Pleur-evac

Question 6

What do you do once a chest tube is in place?

Answer 6

Secure the connections

Question 7

Daily assessment of the drainage system

Answer 7

STOP
S- site (dressing, drainage)
T- tube (taped connections, dependent loops)
O- output (record q8h, document I&Os, Excess >100mL/hr, mediastinal should decrease over time, Document any air leak)
P- patient (tidaling in water seal chamber)

Question 8

Stripping chest tubes

Answer 8

Get order from the surgeon
Stripping can increase negative pressure in the tube
Stripping used to be done to “milk” the tube to get out thick secretions- So DONT do it!

Question 9

Troubleshooting- removal

Answer 9

May clamp for several hours- 24 hours

Chest X-ray done

Question 10

Troubleshooting- transport

Answer 10

Maintain upright
Maintain below heart
Order to remove from suction

Question 11

Troubleshooting- changing the system

Answer 11

Prepare new system (pleur-evac)
Clamp CT above the connection
Remove old system and attatch new
Unclamp ASAP

Question 12

What are the ONLY reasons to clamp a chest tube?

Answer 12

Changing the system
Assessing for air leak
Assessing pt.s tolerance for removal

Question 13

Troubleshooting- dislodgement

Answer 13

Any disconnection should be immediately reconnected!

MD needs to be notified

Question 14

What do you do if a chest tube is fully dislodged?

Answer 14

Vaseline to site immediately
Occlusive dressing
Notify MD STAT
Prepare for STAT x-ray
Observe S&S of pneumothorax

Question 15

Chest tube removal

Answer 15

Done my MD
Drainage has decreased to little or none
Pt. breathes normal with no respiratory distress
Breath sounds are equal bilaterally
Fluctuations (TIDALING) in the water seal chamber have stopped
Chest x-ray shows lung re-expansion with no residual air or fluid in pleural space

Question 16

During chest tube removal, MD will…

Answer 16

Remove the insertion site dressing, clean area, and remove sutures
During peak exhalation, remove tube in one quick motion
Immediately apply sterile occlusive petroleum gauze to wound. Purse-string suture will be pulled close
Occlusive dressing
Chest x-ray
Assess respiratory status & Spo2 for 1-2h after removal (longer if needed)