Chest Tubes Flashcards
Where are chest tubes placed?
Chest tubes are placed in the pleural space for the purpose of draining air or fluid and relieve resp distress
-comfort, perfusion and ventilation
Who inserts the chest tube?
Placed by physician
Catheter is placed through chest wall into intrapleural space
Catheter is sterile tube with drain holes to remove blood, air and fluid and prevents return of fluid
Indications for chest tube?
Pneumothorax (air) Hemothorax (blood) Pleural effusion (fluid) Empyema (pus) Chylothorax (lymph) Cardiac tamponade (pooling of blood around heart)
Visceral vs parietal pleura?
Visceral: covers the lungs
Parietal: covers thoracic cavity
Serous fluid between the 2 membranes
What is negative pressure?
Pressure that is less than atmospheric pressure in intrapulmonary space
What does negative pressure do?
Allows air to enter but not escape
Pleural fluid keeps alveoli from collapsing
Allows lungs to expand
What keeps lungs from collapsing?
Residual volume of air that keeps small airways always open
The surface tension of the serous fluid between the pleura together with the pressure induced by pulling action of the diaphragm
Where is tubes placed that are used for air only?
Placement is usually the anterior cheat on the mid clavicular line at the 2nd and 3rd intercostal space
Located here because air rises to the highest point in the chest
Patient should be in semi to high fowler
Tube location for blood, puss or effusion?
Usually placed lower in the chest on the mid axillary line of the 4th or 5th intercostal space
Patient should be in high fowler to facilitate gravity draining
Pneumothorax?
Air enters chest cavity causing loss of negative pressure
Limits lung expansion
Causes: blunt trauma, spontaneous in young males
S&S: sharp pleuritic chest pain, decreased breath sounds, SOB
Tension pneumothorax?
Rapidly growing air causing increase in pressure within pleural cavity
Life threatening
Causes shift
Pleural effusion?
Non bloody fluid in the pleural space
Fluid takes up space in thoracic cavity resulting in decreased lung volumes
Cause: disease or inflammation
S&S: dull, achieve chest, decreased breath sounds, cough, dyspnea
Empyema?
Pus in pleural space
Causes: infection, post op complication
S&S: cough, dull aching pain, decreased breath sounds, dyspnea, fever
Hemothorax?
Collection of blood in the intrathoracic space
Cause: lacerated lung or vessel or blunt/penetrating trauma
S&S: sudden sharp pain, shock, SOB, tachypnea
3 basic components of chest drain system?
Water seal chamber
Suction control level and indicator
Collection chamber
Where is suction control level and indicator?
Upper left side of pleur-evac unit
- turn dial to desired suction level
- can be connected to gravity or suction
Top left corner, fluorescent float is suction control indicator in little window beside suction dial
What determines amount of suction?
Suction unit determines amount of suction regardless of amount turned on on the wall
Water seal chamber?
Used to provide funnel to fill the water seal chamber with 2cm of sterile water
It allows air to exit from the pleural space on exhalation and prevents air from entering back into chest on inhalation
Little circle on bottom left corner window
Patient air leak meter?
Indicates the approximate degree of air leak from the chest cavity
-the higher the number the greater degree of air leak
Bottom left window
Positive pressure relief valve?
Opens with increase in positive pressure, preventing pressure accumulation
do not obstruct positive pressure valve
Top left valve
High negatively float valve and relief chamber?
Preserves the water seal in the presence of high negativity. Used to reduce negativity.
Action:
- water floats the valve up into the closed position when excessive negativity occurs
- valve opens upon decrease in negativity
Connected to air leak meter
High negative relief valve?
Used to vent excessive negativity
Depress button to relive negativity
Causes filtered air to enter the unit and the water level in the water seal will drop
Release button when desired level of level of negativity is reached
Top right valve
Collection chamber?
Used to collect drainage
Fluids overflow from one section to the next
Total capacity is 2500cc
Located on tubes on right
Routine assessment for chest tubes?
ABCs Resp distress Chest pain Breath sounds over affected lung VS Correct position Palpation: subcu emphysema Unit in upright position and below level of insertion Environment Dressing Tubing free from kinks and clots Listen for leaks Fluid check (2cm) Amount and type of drainage Suction
What’s it called when water moves up and down the water seal chamber?
Tidaling
What can occur with a chest tube?
Atelectasis
What position should the patient be in when they have a chest tube?
Semi or high fowlers
Semi: to evacuate air
High: to drain fluid
What can LPNs do with chest tubes?
LPNs can check and maintain chest tube equipment
Assist with set up and dressing changes
Monitor and asses
Report to RN and physician
How frequent should assessments be done?
Every 4 hours unless pt condition changes
What should always be in reach of chest tube?
2 clamps
- no teeth
- RN only
Clamping creates closed system
When to use a clamp?
Changing unit
W/ physician order
Following instillation
Assessing for air leak
Chest tube dressings?
Requires cleaning and monitoring
Change as per order q2days and PRN
Do not use waterproof tape on skin at insertion site
What happens if chest tube is pulled out?
Cover with gauze
Tape only 3 sides
Call doctor
Potential of entry of microorganisms
What to do if there’s pooling of secretions?
Need to change tension and proper positioning of tubing
Potential for pathogen build up
How to decrease risk of patient pulling out tube?
Have tubing where they can see it so they don’t accidentally dislodge or roll over on it
Assessment at insertion site?
Discharge
Redness
Shadowing
Dampness
Signs of infection*
What to check if someone is experiencing SOB with chest tube?
Assess breath sounds
Is tubing secure?
Is tubing kinked, obstructed?
Is the clamp open?
Bubbling in air leak meter?
Check and tighten connections
Test tubing for leaks
Check insertion site for obvious leaks?
One way valve?
Let’s air and fluid pass in one direction only
Ex. Heimlich flutter valve
Used for simple pneumothorax
Potential complications of chest tube?
Air leak
Severe resp distress or chest pain
Absence of breath sounds of affected side
Dependent loops of drainage trapped
Absence of fluctuation with respirations
Chest tube dislodged
Bleeding
What to do if patient shows resp distress or chest pain?
Stay with patient
Call bell for RN or physician
Is drainage system in right position?
What do you do if there’s absence of breath sounds?
Code blue
What to do if there’s dependant loops with fluid trapped?
Drain into drain bottle
Reposition tubing
Patient teaching
Valsalva maneuver?
the action of attempting to exhale with the nostrils and mouth, or the glottis, closed.
What time of pressure is maintained during expiration?
Negative pressure
