chest tubes Flashcards
What do you suspect if you walk into your patients room and their pleurevac is bubbling continuously? How do you respond to this?
air leak 1. Assess the patient 2. Assess system integrity 3. Assess the chest tube **If still bubbling: Clamp the chest tube close to the site of insertion. If the bubbling stops, the leak is from the patient. If it continues, there is a system leak. Change the system.
You are caring for a patient with a pleurovac set at -20. He is complaining of increased breathlessness and a sharp pain to his right upper chest. What is your first response?
- Stay with the patient*
1. Full set of vitals
2. check integrity of the system
How would your patient with a tension pneumothorax present?
breathless
sharp pain in right upper chest
decreased breath sounds
thick bloody drainange
Tracheal shift and low BP are late signs of….
tension pneumothorax
The physician has asked you to assist in inserted a chest tube. What is required before this procedure can be started?
- physician to obtain informed consent
- baseline vitals/resp assessment
- Gather equipment (thorocotomy tray, chest tube, dressing materials, pleuroovac system)
- position patient (hunched over bedisde table, high fowlers or side lying)
As a nurse, how can you assist the physician in chest tube insertion?
- cleanse the area
- assist in patient positioning
- check allergy band
- chart
- set up
- pre-emptive analgesia
Explain what you would include in an assessment on a patient who just had a chest tube inserted
- prepare patient for x-ray to verify placement
- vitals
- resp assessment
- subcutaneous emphysema
- make note of the drainage
- note bubbling in the chamber
What things need to be included in the emergency kit at the bedside of a patient with a chest tube?
- 2 padded clamps
- sterile water
- occlusive dressing
- gauze
- waterproof tape
- alcohol swab
It becomes apparent that your patient has accidentally dislodged his chest tube. What is your best first response?
STAY WITH PATIENT AND CALL FOR HELP
1. cover the insertion site with gauze and an occlusive dressing and waterproof tape on 3 SIDES
*Must allow air to escape on expiration to prevent the
development of a tension pneumothorax
*Occasionally on exhalation, gently lift the open side to allow air to exit the intra-pleural space
2. Monitor vitals and respiratory status
3. Notify MRP
Upon your morning assessment, you notice what feels like rice krispies popping under your patients skin on their chest. What does this indicate? What is your best response?
- Assess for pain/shortness of breath
2. Use an appropriate marker to mark the spread/decrease of SC emphysema
What rate of drainage in the collection champer is significantly rapid to warrant prompt notification of the physician? Why?
> 200cc over 4 hrs, because patients can go into pulmonary edema quite quickly
When I walk into my patients room in the afternoon, and notice no fluctuations in the water seal chamber on his pleurevac, what does this mean?>
either there is a kink in the system somewhere or the lung has re-expanded!!
What do you expect to see in the air leak chamber?
mild bubbling indicating successful suction
What 3 parts of the pleurevac system must you frequently assess?
- drainage collection chamber
- water seal chamber
- Air leak monitor
What do you expect to see in the water seal chamber?
The water will fluctuate…it will increase with inspiration and decrease with expiration. This means that air can escape but it cannot enter the lung.
