Chest Tubes Flashcards
What is pleuritis?
Inflammation of pleura (#1 sign is pain)
What is a pleural effusion?
Fluid in the lungs
What is a pneumothorax?
Air in the pleural space (lung collapse)
What is a hemothorax?
Blood in the pleural space
Pleural fluid may be transudate or exudate, what is tranudate?
When fluid leaks into the empty space bc of inadequate blood circulation. (Ex. heart failure pts)
Pleural fluid may be transudate or exudate, what is exudate?
Biprodutcs of an infection- empyema
What is empyema?
Pus in lungs
What type of fluid may there be in a pleural effusion?
Blood, pleural fluid, chyle or empyema
What is chyle?
Lymphatic fluid
What are manifestations of pleural effusion?
Dyspnea, increased RR, change in LOC bc of hypoxemia
What are the treatment options for a pleural effusion?
Thoracentesis, if large then chest tubes, or a pleurodesis
What is a thoracentesis?
Large needle placed in thorax to aspirate fluid out for testing
What is a pleurodesis?
Creation of adhesions b/t parietal and visceral pleura to prevent recurrent pneumothorax
How are the adhesions created for a pleurodesis?
Instillation of a chemical agent into chest tube to cause inflammation and scar tissue so fluid can’t build up: Doxycycline or talc
Why is a pleurodesis controversial?
Bc it’s very painful and doesn’t return efficient lung use afterwards bc of the scar tissue that built up in lungs
What is a sensitive indicator to oxygenation status?
Change in LOC
How does a pneumothorax occur?
When visceral or parietal pleura are breached (hole) and air enters pleural space; lung expansion is impaired and lung collapses
What is a traumatic pneumothorax?
Result of blunt or penetrating trauma
What is the diff b/t closed and open traumatic pneumothorax?
Closed: blunt force trauma, fracture. Open: Gun shot, stabbing wound or surgical procedure
What is atelectasis?
Area of the alveoli is not ventilating; partial collapse
What is a tension pneumothorax?
Injury to chest wall where air enters pleural space but is prevented from escaping (positive pressure in pleural space)
What can a tension pneumothorax result in?
Mediastinal shift
What is a mediastinal shift?
Life threatening situation where the unaffected lung shifts to the affected side to fill the space, crossing over the heart
What is the #1 sign of a mediastinal shift?
Tracheal deviation
What happens during a tension pneumothorax?
Severely compromised ventilation, impaired venous return to the heart
What is medical emergency management is done during a tension pneumothorax?
Needle placed in to ventilate pressure
What are s/s of a tension pneumothorax w/ mediastinal shift?
Hypotension, tachycardia, resp. distress,
What are treatment options for a a tension pneumothorax w/ mediastinal shift?
Insertion of a large bore needle @ the 2nd intercostal space, midclavicular line to remove fluids; chest tube insertion to relieve pressure
What is used to re-expand the lung, remove air, fluid and blood, and can have suction added to facilitate removal of air and fluid?
Chest tubes
What are the important items needed in a room if a pt has a chest tube in place?
Sterile water, 2 blue clamps, petrulatum gauze, 4x4, microfoam tape/tegaderm
What type of chest tube is used for blood?
Trochanter catheter
What type of chest tube is used for fluid?
Transudate catheter- “pig tail”
What are the key chest tube assessments?
Water seal, drainage amount (document COCA from tubing), air leak, fluctuation (tidaling), SC air
If normal suction is used what is the cm of water used?
-20cm
The most important thing to have intact is the water seal system; what should the under water seal be at?
@ -2cm water line to prevent atmospheric air from entering the lung
For (+) fluctuation in response to respiration the ball in B column should what?
Rise w/ inspiration and fall w/ expiration
If fluctuation is (-) what could be the reason?
Pt could be laying on tube, could be a clot or lung has re-expanded
If a pt is on positive pressure mechanical ventilation what should occur w/ fluctuation?
The opposite- fall w/ inspiration and rise w/ expiration
If there is intermittent bubbling in the water seal what does this mean?
Positive air leak from pleural space that needs to come out
If there is continuous bubbling in the water seal what does this mean?
Air is getting into system from a hole in the tube or a misplaced cath
If there is continuous bubbling what should you do?
Clamp the tube starting from the entrance to see if it is from the system (bubbling should stop), if not work your way down the tube to see where in the tube the hole is
If a pt is hooked up to suctioning what should you do in order to get a thorough assessment?
Turn off suction
What is wet suction (Ocean)?
Chamber A is filled w/ sterile water and connected to a suction source; should bubble GENTLY
What can the gentle bubbling do to the water seal?
Evaporate water so might not be at -2 water seal line, so turn off suction to double check
What is dry suction (Oasis)?
Suction that has a dial that regulated the amount of suction, water not needed
How do you know if the dry suction is on or working?
Orange bellos in column E should be going across the chamber
Dry suction systems w a one-way valve, hemilich valve, and pleurX catheter are all what?
Types of chest drainage systems
What are chest tube emergencies?
Chest drainage device breaks w/ loss of water seal; chest tube is pulled out
If the drainage system cracks and loses its water seal what should you do?
Quickly put the chest tube in the bottle of sterile water
What should you do if the chest tube is pulled out?
Apply the petrolatum gauze over site immediately taping THREE of the 4 sides to prevent a tension pneumothorax, place in high fowlers position, apply O2, monitor VS/signs of mediatinal shift and notify doc
