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342 > Chest Tubes > Flashcards

Chest Tubes Flashcards

1
Q

Is the pleural space normally positive or negative pressure?

A

Normally negative pressure

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2
Q

What is pneumothorax?

A

The parietal or visceral pleura is breached and the pleural space is exposed to positive atmospheric pressure
Air enters the pleural space and the lung collapses

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3
Q

What are 3 types of pneumothorax?

A
  • Simple
  • Traumatic
  • Tension
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4
Q

What is simple pneumothorax?

A

Occurs when air enters the pleural space through a breach of either parietal or visceral pleura

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5
Q

T or F:

Simple pneumothorax will NOT occur in an otherwise healthy person

A

F, it can

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6
Q

What in simple pneumothorax associated with?

A
  • Diffuse interstitial lung disease

- Severe emphysema

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7
Q

Mnfts of simple pneumothorax?

5

A
  • Minimal respiratory distress with slight chest
    discomfort and tachypnea
  • Trachea midline
  • Expansion decreased
  • Breath sounds diminished
  • Percussion reveals normal or hyperresonance
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8
Q

When does traumatic pneumothorax occur?

A

When air escapes from a laceration in the lung itself or enters through a wound in the chest wall

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9
Q

Traumatic pneumothorax is often accompanied by ___________

A

Hemothorax

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10
Q

What is open pneumothorax?

A

Pneumothorax that occurs when a wound in the chest wall is large enough to allow air to pass freely in and out of the thoracic cavity with each attempted respiration

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11
Q

What are “sucking chest wounds”?

A

During open pneumothorax, the attempted resps make a sucking sound

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12
Q

What is the term used when the lung collapses and the structures of the mediastinum shift toward the uninjured side with each inspiration and in the opposite direction with expiration?

A

Mediastinal flutter or mediastinal swing

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13
Q

What is tension pneumothorax?

A

Air enters the pleural space from a lacerated lung or a small hole in the chest wall, the air that enters is trapped and can’t be expelled during expiration.
With each breath tension (positive pressure) increases causing the lung to collapse and the heart, great vessels and trachea to shift toward the unaffected side

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14
Q

How is CO affected by tension pneumothorax? Explain.

A

Increased pleural pressure decreases venous return to the heart

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15
Q

Mnfts of tension pneumothorax?

know at least 3

A
  • Trachea shifted away from affected side
  • Chest expansion decreased of fixed in
    hyperexpansion state
  • Breath sounds diminished or absent
  • Percussion to affected side is hyperresonant
  • Air hunger, agitation, hypoxemia, central cyanosis,
    hypotension, tachycardia, diaphoresis
  • Chest pain, low oxygen sats
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16
Q

In an emergency situation how can tension pneumothorax be decompressed?

A

By inserting a large bore (14g) needle at the second intercostal space, midclavicular on the affected side

17
Q

When would a pt receive a thoracotomy (surgical opening of the chest wall)?

A

When there is more than 1500mL of blood aspirated initially or when chest tube output continues > 200mL/hr

18
Q

How much fluid should normally be in the pleural space?

A

7-20mL of fluid

19
Q

What conditions can increase pleural fluid entry or decrease fluid exit from the lung?

A
  • Cancer
  • Infection
  • Pancreatitis
  • Connective tissue disease
  • Autoimmune diseases
  • Asbestos exposure
  • Some drugs
  • Collagen vascular diseases
20
Q

What is spontaneous/primary pneumothorax?

A

D/t rupture of a small bleb (blister) on the surface of the lung or an invasive procedure

21
Q

What is secondary pneumothorax?

A

D/t underlying disease such as emphysema

22
Q

What is hemothorax?

A

Collapse of the lung caused by accumulation of blood and fluid , usually d/t trauma

23
Q

Which insertion site for chest tubes promotes air removal?

A

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

24
Q

Which insertion site for chest tubes drain fluid?

A

Low (5th or 6th intercostal space) and posterior or lateral chest tubes

25
Q

Where are mediastinal chest tubes placed? What is their role?

A

Just below the sternum and drains blood or fluid preventing accumulation around the heart

26
Q

What is a Heimlich valve? When is it used?

A

A one way valve used for air to be released but can’t re-enter

27
Q

What are the systems of choice for draining hemo/pnuemothorax?

A

Two or three chamber drainage systems drain hemothorax and pneumothorax effectively

28
Q

What is used to remove secretions when a small chest tube becomes blocked with blood clots?

A

Large bore catheter (28F)

29
Q

T or F:

Milking/stripping tubes causes a dec in intrathoracic pressure

A

F, causes a dangerous increase

30
Q

2 easy ways to avoid occlusion of chest tube drainage?

A
  • Avoid dependent loops - if they cannot be avoided,
    lift and clear every 15-30 minutes
  • Keep the system below the chest
31
Q

How do the fluid levels on a chest tube system change during respirations? Is this different for pts on a ventilator?

A

Fluid levels will rise during inspiration and fall during expiration, but if they are on a ventilator it will do the opposite

32
Q

What might indicate a leak in the chest tube?

A

Constant left-to-right bubbling or violent rocking

33
Q

How often should you monitor chest tubes?

A

Monitor every hour initially, then every 4 hours

34
Q

What does frank blood in chest tubes indicate?

A

Hemothorax

35
Q

What does pus in chest tubes indicate?

A

Empyema

36
Q

What does continuous bubbling in the water-seal chamber with an absence of bubbles in the suction-control chamber indicate?

A

A leak

37
Q

What should you do if the chest tube becomes dislodged?

A

Apply pressure and a petroleum gauze dressing on pt exhale

38
Q

What is considered excessive chest tube drainage in children?

A

3mL/lg/hr for more than 3 consecutive hours

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