Chest Tubes

Question 1

A chest tube goes by many different names, including _______________ tube and chest drain. The plastic tube enters the side of the patient’s chest to remove _____________ from around the heart and lungs.

Answer 1

chest drainage; blood, air, or fluid

Question 2

The lung contains two tissue layers called _______________ that contain fluid that assists the lungs with helping patients breathe. Conditions and diseases—such as pleural effusion, emphysema, tumors, heart failure, hemothorax, infection, and pneumothorax—may cause ____________________-

Answer 2

pleura; blood, air, or additional fluid to gather in the pleural space.

Question 3

The chest tube helps the patient breathe better by _________________ the lungs. Without the use of a chest tube, patients who have certain conditions and diseases may have their lungs________________ if the pressure becomes too great in their chest.

Answer 3

expanding; collapse

Question 4

The chest tube should contain approximately 6 feet of tubing that connects to a _______________-device located several feet below the patient’s chest. Instruct the patient not to rest the body on the tubing. The nurse should take this time to check the patient’s tubing for ______________ in the tubing line. The nurse should also ____________ the tubing connections to prevent air from leaking out of the tube.

Answer 4

collection; twists and kinks; tape

Question 5

The drainage system has a _________ seal that operates as a _____________valve. The nurse must add the required amount of _____________ into the patient’s separate water chamber while ensuring the end of the patient’s tubing ____________ in the fluid.

Answer 5

water; one way; saline; remains

Question 6

Add ______________ to the chest drainage system if necessary, but remember that the amount of ________ depends on the saline solution’s depth.

Answer 6

suctioning; suctioning

Question 7

The respiratory status of the patient requires frequent assessment to maintain the patient’s health. Nurses should also make note of ______________ breathing sounds near the side of the patient’s chest tube.

Answer 7

decreased

Question 8

To maintain the care of the chest tube, nurses should encourage the patient to perform _________________ or _________________

Answer 8

deep-breathing exercises or coughing.

Question 9

The complications that patients may experience as a result of the chest tube include _______________ and _____________- in the arm or leg.

Answer 9

infection and blood clots

The blood clots can travel to the patient’s lungs, causing breathing problems and chest pain, which can be life-threatening. The tube can also poke through organs close to the lungs. The chest tube can also move out of place as the patient turns or moves.

Question 10

accumulation of blood within the pleural cavity - what are characteristic symptoms

Answer 10

hemothorax

The symptoms of a hemothorax include chest pain and difficulty breathing, while the clinical signs include reduced breath sounds on the affected side and a rapid heart rate.

Question 11

a tube inserted into the pleural space of the lungs to remove air or fluid and to help the lung re-expand OR it is a tube placed in the mediastinum space to help drain blood or fluid from around the heart after cardiac surgery

Answer 11

chest tube

Question 12

Reasons for chest tube insertion

Answer 12

Cardiovascular surgery

Pneumothorax: air enters into the pleural space and causes the lung to collapse (trauma to the chest or spontaneous)

Pleural Effusion: fluid in the pleural space
Types of Pleural Effusions:
Hemothorax: blood enters in the pleural space and causes lung to collapse (trauma to the chest, disease TB, blood clotting issue)
Empyema (infection in the pleural space)
Chylothorax (lymphatic fluid in pleural space),

Question 13

_________________- chest tubes are usually placed after cardiac surgery to help drain blood from the pericardial space (placed under the sternum) which prevents fluid from compressing the heart which can lead to cardiac tamponade.

Answer 13

Mediastinal

Question 14

a small space that surrounds the lungs that contains a small amount of serous fluid. This small space is surrounded by the parietal and visceral pleurae. These two layers ___________-over each other which creates a negative pressure.

Answer 14

pleural space; glide.

Therefore, if air or extra fluid enters into the pleural space the lungs are severely affected and can collapse.

Question 15

infection in the pleural space

Answer 15

empyema

Question 16

lymphatic fluid in the pleural space

Answer 16

Chylothorax

Question 17

Two types of chest tube drainage systems

Answer 17

Wet Suction (water seal suction)

Dry Suction

Question 18

basic Difference between wet suction and dry suction chest drainage systems

Answer 18

In wet, there is a suction control chamber with water in it

In dry, there is no suction control chamber with water in it. Rather it uses a suction monitor bellow

Question 19

suction regulated by the height of water in the suction control chamber when connected to wall suction

Which type of suction is this ?

Answer 19

Wet Suction

some have stop-cocks to help regulate the amount of bubbling (you will hear bubbling while it’s working….water evaporates overtime so you will have to re-add it)…physician determines the suction level (usually -20cmH2O).

Question 20

This chest drainage system has no water column to control suction but uses a suction monitor bellow (looks like an orange accordion) that balances the wall suction and you can adjust water suction pressure using the rotary suction dial on the side of the system.

Which type of suction is this ?

Answer 20

Dry suction

It allows for higher suction pressure levels, has no bubbling sounds, and water does not evaporate from it as with other systems.

Question 21

It allows for higher suction pressure levels, has no bubbling sounds, and water does not evaporate from it as with other systems.
Which type of suction is this ?

Answer 21

Dry suction

Question 22

Nursing Management of a Chest Tube:

Drainage system itself: we want to

Answer 22

keep system below patient’s chest

Question 23

Nursing Management of a Chest Tube: Tubing: what do we want to make sure

Answer 23

Keep it free from kinks and make sure it is draining freely (not clots or stagnate fluid) and that all connections are sealed

Question 24

Nursing Management of Drainage Collection Chamber

Answer 24

Monitor drainage (color, amount…..should drain no more than 100 cc/hr and record routinely)

Question 25

What does the water seal chamber do ?

Answer 25

performs an underwater seal on the tube to allow air to be removed from pleural space while preventing outside air from entering lungs

Question 26

performs an underwater seal on the tube to allow air to be removed from pleural space while preventing outside air from entering lungs. What chamber of the chest tube does this ?

Answer 26

Water seal chamber

Question 27

Water in the water seal chamber _______________ as the patient breathes in and out. If the patient is breathing on their own the water will _____________ during inspiration and ___________ during expiration (it will be the opposite if the patient is on __________________)

Answer 27

fluctuates; increase; decrease; positive pressure mechanical ventilation

Question 28

In the water seal chamber, is there any intermittent bubbling?

Answer 28

There may be intermittent bubbling, which is expected as air is drained from the pleural space, especially for treatment of a pneumothorax. Remember that a pneumothorax is an AIR leak between the lung and chest wall….therefore air can escape into the water seal chamber causing intermittent bubbles.

Question 29

What potential clinical issues should we watch out for in the water seal chamber ?

Answer 29

No fluctuation at all

Excessive bubbling

Question 30

What if the water seal chamber isn’t fluctuating at all?

What could that mean ?

Answer 30

The lung could have re-expanded or there is a kink somewhere.

Question 31

What is there is excessive bubbling in the water seal chamber ? What does that mean?

Answer 31

There is an air leak somewhere.

Question 32

Nursing Management of Suction Control Chamber for Dry chest drainage system

What is the suction controlled by ?

Answer 32

suction controlled by a dial on the side and is regulated by suction monitor bellow (orange accordion). There is no water column.

Question 33

Nursing Management of Suction Control Chamber for Wet chest drainage system

Answer 33

remember watch the amount of water because it evaporates over time and it should gently bubble due to the suction working.

Question 34

*Water in the water seal and suction control can _____________ over time so watch the water and add as needed.

Answer 34

evaporate

Question 35

Patient Assessment with Chest Tube

Answer 35

Note lung sounds, rate, any dyspnea? Worsening pneumothorax or hemothorax

Note skin around insertion site for any subcutaneous crepitus (crackling sensation felt on palpitation) that is due to carbon dioxide escaping into the tissues.

Keep patient moving by turning frequently, coughing, and deep breathing…helps move fluid and improve lung function

Question 36

What to do if chest tube becomes dislodged?

Answer 36

Cover the site with a sterile dressing, and tape on three sides (this allows air to escape and prevent tension pneumothorax) and notify physician immediately.

Question 37

What to do if system breaks ?

Answer 37

Insert the tube 1 inch into a bottle of sterile water or sterile normal saline and obtain a new system.

Question 38

Milking or stripping tubing?

Answer 38

Not recommended anymore because it creates too much negative pressure (always follow hospital policies)

Question 39

Clamping tubing?

Answer 39

Increase risk of patient developing a tension pneumothorax. Never do it without an order and follow hospital policies.

Question 40

Nurses role for chest tube removal

Answer 40

assisting physician (done at beside)…some facilities allow nurses to do this if they’ve completed proper training and competencies

Gather supplies: sterile gloves, dressing supplies (occlusive, petroleum gauze, Telfa….every physician varies on their preference), mask, goggles, suture removal kit, tape, rubber tipped hemostats)

Educate patient prior to remove and how to do the Valsalva’s maneuver. This is performed by having the patient take a deep breath, exhale, and bear down (prevents air for going back into pleural space). This will be performed by the patient when tube is removed.

Pre-medicate for pain if ordered by physician.

Position patient in Semi-Fowler’s for removal.

Monitor respiratory status, lung sounds, drainage, assess chest for unequal chest rising, and dyspnea.

Note: the patient will have chest x-ray (ordered by the physician) to assess lung expansion after removal.

Question 41

How to do the Valsalva’s maneuver during chest tube removal ?

Answer 41

This is performed by having the patient take a deep breath, exhale, and bear down (prevents air for going back into pleural space). This will be performed by the patient when tube is removed.

Question 42

What position will the patient be in for chest tube removal?

Answer 42

Semi Fowler’s position