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240 > chest tubes > Flashcards

chest tubes Flashcards

1
Q

chest tubes

A

pleural or mediastinal
remove air/fluid from pleural space
restore negative intra-pleural pressure so that lungs can re-expand

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2
Q

pleural space

A

potential space between visceral pleura and parietal pleura

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3
Q

pleural fluid

A

50 mL
produced by pleural cells
separates and lubricates
holds 2 layers together creating negative pressure to keep lungs expanded

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4
Q

when intrapleural pressure is equal to atmospheric pressure

A

lungs collapse

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5
Q

pneumothorax

A

air in the cavity

rib fx, GSW, knife wound, thoracotomy, forceful coughing, bronchoscopy, spontaneous

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6
Q

hemothorax

A

blood in pleural space

open chest procedures or blunt/penetrating trauma

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7
Q

pleural effusion

A

excessive fluid accumulation in pleural space
HF, pneumonia, cancer, PE, post op
thoracentesis if large amts

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8
Q

chylothorax

A

accumulation of lymphatic drainage

chest trauma, expanding tumor, chest surgery

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9
Q

empyema

A

purulent pleural fluid
damages pleural membranes and must be removed
2/2 pneumonia

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10
Q

cardiac tamponade

A

blood accumulation in mediastinal space

post op or chest trauma

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11
Q

instillation of fluids in pleural space

A

chemotherapy
chemical pleurodesis
VATS procedure if recurring (adheres visceral and parietal pleura)

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12
Q

chest tube placement (pneumothorax)

A

2-4th ICS

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13
Q

chest tube placement (fluid)

A

8-9th ICS

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14
Q

water seal

A

prevents air from returning to lung and acts as one-way valve

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15
Q

suction

A

provides negative pressure to chest

aids in reinflating lung more quickly

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16
Q

suction setting

A

-20cm

17
Q

patient presentation (air or fluid)

A

respiratory distress (tachycardia, tachypnea, hypoxia, restless, anxious)

18
Q

white on CXR

A

lung collapse

19
Q

documentation of chest tube insertion

A 
chest tube size
insertion site
drainage
pt tolerance
meds before and during
results of CXR
20
Q

chest tube assessment

A

check for infection around site
change dressing daily
SpO2, lung sounds
assess for subcutaneous emphysema

21
Q

subcutaneous emphysema

A

air under tissue
crepitus
“bubble paper”

22
Q

tubing

A

prevent obstructions!
no dangling or dependent loops
no laying on tube

23
Q

to maintain drainage

A

gentle milking
no stripping/venting
report drainage > 200 mL/hr

24
Q

chest drainage unit (CDU)

A

never! elevate above chest (keep 12 inches below chest)
maintain 2cm water in water seal chamber
mark time of measurement and fluid level every 1-3 hrs
drainage > 100 mL per hour or at PCP direction call MD
red blood may indicate active bleeding

25
Q

tidaling

A

correspond w respirations
rises on inspiration, falls on expiration
reversed on vent pts
no tidaling in water seal chamber!

26
Q

air leak indicator

A

bubbling indicates leak

27
Q

bubbling in water seal

A

intermittent bubbling is normal

continuous bubbling water seal – CHANGE CDU

28
Q

if CDU is overturned

A

return to upright position
avoid by taping CDU to floor or hanging off bed
deep breaths followed by forced exhalation, cough

29
Q

if chest tube is pulled out

A

pinch skin together
petroleum/occlusive dressing
PCP

30
Q

if CDU breaks or has an air leak

A

place distal end of chest tube in 2 cm sterile water to recreate water seal

31
Q

clamps bedside

A 
2 rubber tipped hemostats
when changing CDU/full
assessment before removal of CT to assess pt tolerance
assessment for air leaks
never clamp with out PCP order
32
Q

improper clamping risk

A

tension pneumo

cardiac tamponade

33
Q

changing CDU

A
  1. set up new unit
  2. clamp
  3. disconnect from “filled” CDU
  4. reconnect to new CDU
  5. remove clamp
34
Q

indications for removal

A 
drainage has decreased (little to none)
pt breathing normally w/o distress
breath sounds at baseline
no fluctuations in water-seal chamber
CXR shows lung re-expansion with no residual air or fluid in the pleural space
35
Q

chest tube removal

A 
medicate 30 min prior
PCP removes sutures
deep breath, removed on expiration
dressing applied
CXR
monitor respiratory status, pain, infection
36
Q

short term chest tube

A

blake drain

pigtail catheter

37
Q

longer term chest tube

A

pleurex catheter

38
Q

home chest tubes

A

heimlich valve

pneumostat chest drain

39
Q

heimlich valve

A

for small uncomplicated pneumo
no need for suction
one way flutter valve to allow air to exit

240 (7 decks)

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