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Nursing 342 > Chest Tubes > Flashcards

Chest Tubes Flashcards

1
Q

indications for chest tubes

A
  • treat conditions that disrupt pleural space
  • prevent or mitigate post op complx
  • instill fluids into pleural space, such as chemo drugs or sclerosing agents to treat recurrent pleural effusions
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2
Q

can be blood collected from chest tubes be used?

A

yes for autotransfusions

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3
Q

what is the goal of chest tube therapy?

A

to promote lung re-expansion, restore adequate oxygenation and ventilation, and prevent complications

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4
Q

what objectives should chest tube therapy focus on?

A
  1. removing air and fluid as promptly as possible
  2. preventing drained air and fluid from returning to the pleural space
  3. restoring negative pressure within the pleural space to re-expand the lung
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5
Q

difference between larger and smaller chest tubes?

A
  • larger tubes used to drain blood and transudate

- smaller tubes use to remove air

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6
Q

what size chest tube is used in adults?

A

24-40 French

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7
Q

how is the patient positioned during insertion of a chest tube?

A

depends on insertion site, whether air or fluid will be drained, and pt’s clinical status. generally the pt is supine with a wedge or bolster placed under shoulders

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8
Q

where anatomically is a chest tube placed?

A

midaxillary line between the 4th and 5th ribs on a line lateral to the nipple

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9
Q

potential complx

A
  • bleeding if a vessel is cut
  • risk for infection
  • subcutaneous emphysema
  • pneumothorax, hemothorax
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10
Q

what happens when subcut emphysema occurs ?

A

pleural space air leaks into subcut tissue, causing tissues of neck, face, and chest to swell and crepitus on palpation

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11
Q

how do you monitor for s&s of complx and prevent it?

A
  • note changes in drainage amount and character, which may indicate increased bleeding or new-onset infection
  • keep tubing free of kinks and occlusions
  • regular dressing changes
  • assess insertion site for subcut emphysema and tube migration
  • monitor water levels in water seal and suction control chambers
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12
Q

when and what should you document?

A

comprehensive pulmonary assessment every 2 hours

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13
Q

tidaling

A

fluctuations in the water-seal chamber with respiratory effort; is normal

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14
Q

if tidaling doesn’t occur, what is happening?

A

tubing may be kinked or clamped, or dependent tubing has become filled with fluid

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15
Q

what does intermittent bubbling mean?

A

if it corresponds to resps in water seal chamber, it indicates an air leak from the pleural space

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16
Q

bubbling in water seal container is continuous. what does this mean?

A

leak in the system

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17
Q

why do we avoid milking or stripping the tube?

A

can generate extreme negative pressures in the chest tube and does little to maintain chest-tube patency

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18
Q

what can you do if you see visible clots?

A

squeeze hand-over-hand along the tubing and release the tubing between squeezes to help move the clots into the CDU

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19
Q

why do you want to avoid clamping?

A

prevents the escape of air or fluid, increasing the risk of tension pneumothorax

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20
Q

what do you do if a chest tube becomes disconnected and contaminated?

A

submerge the tube 1”-2” (2-4 cm) below the surface of a 250mL bottle of sterile water or saline solution until a new CDU is set up

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21
Q

by placing tube in sterile water or saline solution after it has been contaminated, what are we doing?

A

establishes a water seal, allows air to escape, and prevents air re-entry

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22
Q

indications for chest tube removal

A
  • improved respiratory status
  • symmetrical rise and fall of the chest
  • bilateral breath sounds
  • decreased chest-tube drainage
  • absence of bubbling in the water-seal chamber during expiration
  • improved chest X-ray findings
23
Q

removal of chest tube steps

A
  • explain procedure to pt, make sure they know how to do vasalva maneuver
  • admin of analgesics
  • dc suction
  • position pt in semi fowlers
  • remove dressing and sutures; clamp tubing
  • pull out tube when pt does Vasalva; apply occlusive dressing secured with tape
  • obtain CXR
24
Q

what is nursing care after chest tube removal?

A

ongoing resp assessment, VS, monitor for drainage, comfort level

25
Q

prolonged leaks

A

last more than 5 days after thoracic surgery

26
Q

if you detect leak at insertion site what should you do?

A

apply petroleum gauze and sterile dressing over site

27
Q

what happens with a significant internal air leak?

A

you can palpate subcutaneous emphysema

28
Q

what leads to tension pneumothorax?

A

large persistent leak with no evacuation outlet

29
Q

when should you dc suction before removal?

A

some literature suggests dc-ing suction 24hrs prior to taking out a chest tube to prevent possible air leak

30
Q

when should you obtain CXR after removal?

A

within 2hrs of removal

31
Q

what do you do in an unplanned removal?

A

stay calm, cover insertion site with hand, call for help, cover site with dressing, notify MRP, obtain CXR

32
Q

if you didn’t see the chest tube come out, what do you do?

A
  • If patient appears to be in respiratory distress, ask him or her to exhale forcefully as you lift your hand off the insertion site; before the patient’s next inhalation, quickly cover the site again.
  • Have the patient repeat this a few times
33
Q

if you’re walking with your patient and the chest tube becomes dislodged where it connects to the drainage tubing, what do you do?

A
  • immediately close off the tubing to air with your gloved hand by crimping it or using a clamp, if readily available, or place the end of the tube in a bottle of sterile water, creating a water seal
  • prepare a new sterile chest-drainage collection device, or retrieve a new sterile connector while you safely return the patient to bed
  • observe the patient for s&s of respiratory decline, then reconnect the chest tube to the new drain and unclamp it
34
Q

how does re-expansion pulmonary edema occur?

A

results from rapid removal of large amounts of air or fluid

35
Q

what is a chest tube?

A

large catheter inserted through the thorax to remove fluid (effusions), blood (hemothorax), and/or air (pneumothorax)

36
Q

what placement of chest tubes drain air?

A

Apical (2nd or 3rd intercostal space) and anterior chest tube placement

37
Q

what placement of chest tubes drain fluid/blood?

A

Chest tubes placed low (usually in 5th or 6th intercostal space) and posterior or lateral

38
Q

when is fluid drainage expected?

A

after open chest surgery and some chest trauma

39
Q

when is a mediastinal chest tube used?

A

after open heart surgery

40
Q

two chamber system vs three chamber system

A
  • Two-chamber system permits liquid to flow into the collection chamber, and air flows into the water-seal chamber
  • Three-chamber system promotes the drainage of fluid and air with controlled suction
41
Q

what is similar about both two and three chamber systems?

A

1st chamber provides a compartment for fluid and the 2nd for either a water seal or a one-way valve

42
Q

T or F: Infections can occur with chest tubes.

A

Yes, but rarely

43
Q

management of chest tube drainage system

A
  • Avoid dependent loops of the drainage tube; or when these loops cannot be avoided (such as when pt is sitting), lift and clear the tube every 15-30 mins
  • Keep chest drainage tubing and the collection system below the level of the pt’s chest. Keep the tubing above the collection system to allow drainage by gravity.
  • Tailor the length of the drainage tube to the pt. The tubing must be long enough to allow a pt to move but not so long that dependent loops hang down the side of the bed.
44
Q

what can happen if tubing is coiled, looped or clotted?

A

drainage is impeded and can result in a tension pneumothorax

45
Q

what is not considered normal in water seal chamber?

A

○ Constant bubbling in the water seal or a sudden, unexpected stoppage of water-seal activity is considered abnormal and requires immediate attention
○ Constant left-to-right bubbling (when facing the indicator) or violent rocking is considered abnormal and indicates an air leak

46
Q

what would a sudden decrease in drainage indicate?

A

possible clot or obstruction in the chest tube

47
Q

what indicates fresh bleeding from the thorax?

A

sudden increase of more than 250mL of drainage over 1hr

48
Q

what are the different colours of drainage?

A
  • Drainage from recent open-chest surgery initially is bright red and gradually becomes serous as post-op course continues
  • Blood tinged fluid = malignancy, pulmonary infarction, or severe inflmtn
  • Frank blood = hemothorax
  • Pus = empyema
49
Q

absence of bubbling in three chamber water system indicates what?

A

no suction is occuring; raise suction setting to restore gentle bubbling

50
Q

what happens when appropriate amount of water is added to three chamber water system?

A

a 2cm water seal is established

51
Q

bubbling in water seal chamber indicates…

A

an air leak

52
Q

dry suction system

A

○ Provides higher suction pressure levels if needed, easy setup, no water in suction-control chamber, and absence of continuous bubbling

53
Q

what is the point of the water seal chamber?

A

it acts as a one way valve so air cannot enter the pleural space

54
Q

when setting up a waterless system, what do we add and why?

A

15mL of NS or sterile water into diagnostic indicator injection port; Allows observation of rise and fall of water in diagnostic air leak window

Nursing 342 (6 decks)

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