Chest tubes Flashcards
What does the pleural cavity cover?
The lungs
What does the Mediastinal cavity cover?
The heart
What should be in the pleural cavity?
Nothing except 5-10mL of lubricating fluid for inhale & exhale ease
What is the thorax natural state?
Expansion
What is the lung natural state?
Collapse
The thorax and lungs exist has _____ forces and state of ___ intrapleural pressure?
opposing
Negative
What happens if the negative pressure is lost in the pleura space?
the 2 pleura separate (lung collapses)
Who requires chest drainage?
-Heart failure
-Thoracic surgery
-Central line accidentally gets in intrapleural space
-Spontaneous bleb rupture
-Malignacies
-Decrease in colloidal osmotic pressure
Pneumothorax
Air in pleural space
Spontaneous pneumothorax
no apparent cause
Hemothorax
Blood in pleural space
Thoracotomy
Surgical opening into thorax
Thoracentesis
Removal of pleural fluid with large bore needle (Provider done)
Pleural effusion
excess fluid in pleural space (CXR if >300mLs)
-Impairs oxygenation, decreases surface area, SOB
Empysema
Pus in pleural space
What would you hear if somebody had a pleural effusion?
No or decreased breath sounds
If somebody has open heart surgery what would be in their pleural space?
Blood and air
If somebody has a bleb and spontaneous lung collapse what would be in their pleural space?
air
What is the next best nursing action if <20% pneumothorax?
bedrest, limited activity, let it reabsorb on its own
What is the next best nursing action if >20% pneumothorax?
contact HCP for thoracentesis or insertion of chest tube attached to an underwater seal
What is the nursing action with chest tube insertion?
-Stay w/ patient (painful)
-Premedicate
-Obtain thoracotomy tray, chest tube, & drainage system
-Help maintain correct position
Where would a chest tube be placed if draining air?
Apex of lung
Where would a chest tube be placed if draining blood?
Base of lung
What are the 3 compartment of the atrium?
- Suction chamber
- Water seal chamber
- Drainage chamber
When is increased CT drainage expected?
During ambulation
What does the collection chamber do?
Accepts air or fluid from the system through extension tubing directly attached to the patients chest tube
What does the water seal chamber do?
Acts as a one way valve to prevent airflow back into the patient
-Filled with sterile water to 2 cm mark
(allow air to leave pleural space but not reenter)
What does the suction chamber do?
-Regulates amount of negative suction being exerted on intrapleural space
-Ensure dial is turned
-Has visual alert to indicate correct suction (orange)
Increasing the vacuum suction source will _____ pressure
NOT increase
The extension tubing is either attached to ____ or ________. It should never be _________
Wall suction or Open to air (under water suction)
occluded
What is the danger of clamping/occluding the air vent?
Tension pneumothorax
How much suction is chest tubes typically at?
20cm
When the provider is ready to ‘wean the patient’ from the chest tube, the nurse will receive an order to “change CT from sx to UWS” so the nurse would
Turn off suction
Take tubing off
Leave open to air
Assessment of pt with chest tube in place?
-VS
-Resp assessment: O2 stat, ABG, resp effort, lung auscultation, skin/mucous membrane color, cap refill, CXR findings
-Get OOB
-Aggressive Pulm toilet
Management of pt with chest tube in place?
-HOB raised
-Collection chamber below level of chest
-ATC pain meds
-Teach about pul toilet/ Splinting
-ROM exercises w/ affected should
How should you assess insertion site?
-Occlusive, dry, intact
-Bleeding: mark edge of are and notify HCP
-Palpate for subcutaneous emphysema (aka crepitus) which is atmospheric air in subQ space, notify HCP
How should you assess the extension tubing?
Ensure connections intact & avoid excessive dependent looping
How should you assess the collection chamber?
-Check blood/fluid output
-Not volume and appearance
-Chart I&O and mark
-Expected increase ambulation
-Expected decrease sleeping
How should you assess the water seal chamber?
-ensure water level at 2cm w/ sterile water
-Assess for fluctuations or tidaling if under water suction
-Assess for abnormal bubbling (intermittent is okay continuous is not)
Is it expected to see tidaling in the water chamber when the pt coughs?
Yes
What does no tidaling mean?
- lungs have re-expanded or time to take out
- kink/ obstruction
- suction is on
What does continuous bubbling mean?
potential leak in system
If continuous bubbling noted in the water seal, what should you do?
Gently apple a padded clamp on drainage tubing close to occlusive dressing momentarily
If bubbling stops with clamp–>
indicates leak at exit site or inside pt
If bubbling continues with clamp–>
indicate air leak is between clamp and drainage system (check connections or replace system-nurse can do it)
When is it appropriate to clamp a chest tube?
- Determine air leak location
- To replace drainage system
- If provider orders it (see if pt tolerates it before removal)
NO clamping during transport or if accidentally disconnected
What is a pneumostat?
For the pt who sis ready to go home but chest tube not quite ready to come out
(like pneumothorax)
What is a PleurX catheter system used for?
-Recurrent pleural effusions (HF or malignancies)
-Malignant ascites (fluid in peritoneum)
When does a patient drain fluid with a pleurX catheter system?
Drains at home when symptomatic
Benefits of PleurX?
-Less hospital trips & decreased length of stay
-pt has control
-decreased resp complications
-safe and easy
Which pt gets CT to suction vs UWS?
Provider decision
Usually start on suction than UWS
The provider orders the pt with a CT to walk in hall TID. Can that be done?
Yes, x2 nurses. If connected to suction disconnect adn leave air vent to open and keep drainage container low
What do i do if CT inadvertently pulled out of the chest?
Vaseline gauze (occlusive) placed on exit site to prevent atmospheric pressure from entering pleural space
What to do if the tubing accident ally becomes disconnected?
Take tube that is disconnected and stick it in bottle of sterile saline and create immediate UWS that way
Chest tube removal-
-Done by provider
-Cut sutures
-Apply sterile petroleum gauze dsg
-Have pt to take deep breath & bear down
-Remove tube
-Airtight dressing applied
-Mark drainage
