chest tubes Flashcards
Patient Assessment
Patient Assessment Vital signs (including pain)
Respiratory and oxygenation status (chest auscultation, LOC, SpO₂, skin/mucous membrane coloring, and respiratory effort
Chest Tube Insertion Site
Chest Tube Insertion Site Dressing should be occlusive, dry, and intact.
Monitor for:
o Excessive bleeding through the dressing
o Air leak: palpate around dressing site for subcutaneous emphysema
Chest Drainage System- Drainage Unit
o Upright and below the level of the heart.
o If not attached to bed and placed on the floor, assure that the floor stand is swung out so that the unit does not tip over
Chest Drainage System- Extension Tubing
o Check all connections
o All connections between the patient and drainage system must be secured by Tygun/cable
o Loop extension tubing horizontally on the bed to avoid excessive dependent looping which may ↓ drainage flow
Chest Drainage System- Collection Chamber
o Monitor fluid output in the collection chamber
Volume – Be aware of expected volume of bleeding for the 1st 24 hours following surgery. Be alert for drainage above acceptable volume.
Appearance – Monitor appearance (sanguineous, serosanguineous, serous, purulent). Be alert for a reversal in the drainage appearance (e.g. from serous to bright sanguineous) as it may represent hemorrhage complications.
o Do not strip tubing. Milk chest tubes only on a physician’s order. E.g. if clots are present, gently milk the tubing to facilitate movement of the clots into the collection chamber.
o Routinely mark the volume on the outside of the chamber indicated date + time of marking.
Chest Drainage System-Water Seal
o Assess for the presence of abnormal (constant) bubbling which indicates a system leak.
o Check water level and refill if necessary to maintain 2 cm level.
Chest Drainage System-Suction Chamber
o Check level of water in the chamber to assure that it is at prescribed level (e.g.-20 cm H₂0) and adjust up or down if necessary.
What would you report?
Excessive drainage or sudden change in amount of drainage
No fluctuation/tidaling in the water seal compartment and/or blockage is suspected
Excessive continuous bubbling in the underwater seal compartment
Sudden change in patient’s condition:
o Rapid shallow breathing
o Cyanosis
o Pressure in the chest
o Sudden onset of severe pain
o Subcutaneous emphysema
o Hemorrhage
o Changes in air entry
o Symptoms of mediastinal shift (dyspnea, chest pain, tracheal deviation, decreased blood pressure, increased pulse, cool and mottled skin)
If chest tube disconnects from drainage unit
Sterile water must be located at the bedside to use in case of accidental disconnection of chest tube from drainage apparatus.
If a chest tube becomes disconnected, clean the end with alcohol swab, re-connect and tape
Or
Place chest tube in sterile water. Then assemble and attach chest tube to a new drainage unit.
Notify the physician.
Dressing Change
o Change dressing when soiled or wet, or according to unit policy
o If dressing is changed, note appearance of tube insertion and suture sites
o Using aseptic technique, a petrolatum dressing may be placed around the chest tube insertion site. In SHR, some units use drain gauze, ABD’s and Hypafix ™ tape.
o Clamping the chest tubes
Chest tubes may be clamped on a physician’s order to:
a. Assess if chest tube is ready for removal
b. Remove the chest tube
Chest tube may be clamped for less than a minute to:
a. Change the chest drainage unit
b. Locate an air leak source (bubbling will be continuous in the water seal compartment)
c. Assess bubbling and fluctuation/tidaling of the unclamped chest tube when 2 chest tubes are attached to the same drainage unit
