Chest Tubes Flashcards
What is Boyle’s law?
When the volume of a container increases, the pressure decreases.
When the volume of a container decreases, the pressure increases.
What are indications for chest tube placement?
Pneumothorax Hemothorax Pleural effusion Empyema Chylothorax Pleurodesis of recurrent malignant effusions
What are three treatment goals for pleural conditions?
Remove fluid & air as promptly as possible
Prevent drained air & fluid from returning to the pleural space
Restore negative pressure in the pleural space to re-expand the lung
How does a drainage device help to prevent air and fluid from returning to the pleural space?
Chest tube is attached to a drainage device
Allows air and fluid to leave the chest
Contains a one-way valve to prevent air & fluid returning to the chest
Designed so that the device is below the level of the chest tube for gravity drainage
How does a chest drainage system work? (Gravity vs. suction)
Expiratory positive pressure from the patient helps push air and fluid out of the chest (cough, Valsalva)
Gravity helps fluid drainage as long as the chest drainage system is below the level of the chest
Suction can improve the speed at which air and fluid are pulled from the chest
What is a Pleur-evac?
A chest drainage system.
Pleur-evac
Disposable unit
Needle-less system
Can be connected to suction or left open to gravity
Consists of:
- Collection Chamber
- Water Seal Chamber
- Suction Control Chamber
Where is the suction control level indicator located?
Location:
- upper left side of the pleur-evac unit
- turn the dial to the desired suction level line -10, -15,-20, -30,-40 cm of H2O
How do you adjust the suction level on a pleur-evac?
-When connected to suction, increase the amount of wall suction until the orange float appears in the window (usually about 80-100 cm H2O of wall suction)
Which determines the level of suction, the setting on the suction unit (pleur-evac) or the wall suction?
The setting of the suction unit determines the approximate amount of suction “regardless” of the amount of WALL suction
What is the purpose of the water seal chamber?
To allow air to exit from the pleural space on exhalation and prevent air from entering the pleural cavity or mediastinum on inhalation
How should you add water to the water seal chamber on a pleur-evac?
Use the provided funnel to fill the water seal chamber to the 2cm water level with:
STERILE WATER
What is the purpose of the patient air leak meter on the pleur-evac?
Indicates the approximate degree of air leak from the chest cavity
What action should be taken regarding air leaks?
Observe bubbling in the columns of the patient air leak meter
The meter is labeled from LOW (1) to HIGH (7)
The higher the numbered column which bubbling appears, the greater the degree of air leak.
What is the purpose of the positive pressure relief valve?
Opens with increases in positive pressure, preventing pressure accumulation
What is one thing to be cautious of with the positive pressure relief valve?
WARNING!!!
Do not obstruct the positive pressure relief valve
What is the purpose of the high negativity float valve on a pleur-evac?
Preserves the water seal in the presence of high negativity. Used to reduce negativity.
How does the high negativity float valve work?
water floats the valve up into the closed position when excessive negativity occurs
Valve opens upon decrease in negativity
What is one thing to be cautions of when using the high negativity float valve?
If suction is not operative while depressing this valve, negative pressure may be reduced to zero (atmosphere) and may result in a pneumothorax
What is the purpose of the collection chamber of a pleur-evac?
To collect drainage
How does the collection chamber on a pleur-evac work?
The collection chamber is callibrated up to 2500cc
Fluids overflow from one section to the next
Total capacity of the chamber is 2500cc
When should a pleur-evac be clamped?
Changing a pleur-evac
Assessing for system leak/ air leak
After pleurodesis for malignant effusions/ sclerosis
Prior to the removal of the chest tube with a physician order
What should be done prior to insertion of a chest tube?
Obtain informed consent
Complete Baseline vital signs (HR, RR, BP, Sp02)
Complete respiratory assessment
Gather equipment if procedure is done at bedside
What equipment is necessary to bring to the bedside prior to inserting a chest tube?
Thoracotomy tray
Chest tube
Dressing material (mepore, drain sponge)
Pleur-evac
What should be done after insertion of a chest tube?
Prepare patient for chest x-ray Vital Signs (HR, RR, BP, Sp02) – see agency policy for frequency Respiratory assessment Palpate around site for subcutaneous air Note drainage amount, colour, type Note the presence of bubbling in the water seal chamber Have two padded clamps at bedside 250-500ml bottle of sterile water
When should assessments be done for a patient with a chest tube?
At the start of shift and every four hours (or more frequently depending on findings and agency policy)
What assessments need to be done for patients with a chest tube?
Respiratory assessment Vital signs Presence of chest pain Trachea position Chest tube dressing intact and Presence of subcutaneous emphysema
How should the chest drainage system be assessed?
System below level of patient’s chest
Tube free of kinks, or external obstruction and coiled on patients bed
All connections secured
Color and amount of drainage – should be marked at start of shift and according to policy
Fluctuation of fluid level in water-seal chamber
Constant bubbling in water-seal chamber (if pneumo or suction present)
Float in appropriate location indicating appropriate suction
What should you do if the chest tube falls out?
Stay with the patient
Monitor vital signs and respiratory status
If the chest tube falls out and there is an air leak present (or you are unsure whether there is an air leak), what should you do?
Cover with gauze dressing and tape on 3 sides
Occasionally on exhalation, gently lift open side to allow air to exit intra-pleural space
If the chest tube falls out and there is no air leak present, what should you do?
Cover site with occlusive dressing and secure
What should you do if the chest tube disconnects?
Cleanse both ends with alcohol swab
Notify physician
If visibly contaminated, place chest tube in bottle of sterile water until new system can be set up
What should you do if the pleur-evac unit tips over or integrity is compromised?
Replace the unit
What should be documented on a patient with a chest tube?
Respiratory assessment
Condition of the chest tube insertion site
All tubings and connections tight
Colour, consistency, and amount of any drainage
Presence of subcutaneous emphysema
Presence of tidalling in water seal chamber
Presence of bubbling in water seal chamber
Amount of suction
Patient tolerance and education
When is a chest tube ready to be removed?
No air leak evident the day before considering chest tube removal
Drainage less than 50cc/8 hours or 100cc/day
Patient able to tolerate chest drainage system being brought to water seal from suction
Chest x-ray shows complete re-expansion of the lung
What should be documented after removal of a chest tube?
Tolerance of the procedure Respiratory Assessment Vital signs (HR, RR, BP, Sp02) Post procedure dressing Patient teaching
