Chest Tubes and Central Venous Devices

Question 1

What is pneumothorax?

Answer 1

Acculturation of air in pleural cavity that leads to partial/complete lung collapse.

Question 2

What is hemothorax?

Answer 2

Collection of blood in pleural space. Buildup of blood can cause lung to collapses

Question 3

What is pneumohemothorax?

Answer 3

When air and blood enter pleural cavity

Question 4

What is empyema?

Answer 4

Build up of pus in pleural cavity

Question 5

What is spontaneous pneumothorax?

Answer 5

Can occur in patients with COPD who have a burst bleb that causes air leak into the pleural space

Question 6

Where to place chest tube for air?

Answer 6

Anterior through 2nd intercostal space because air is lighter then blood.

Question 7

Where to place chest tube for blood/fluid?

Answer 7

Posterior through the 8/9 intercostal space.

Question 8

What does the chest tube do and where to put it?

Answer 8

Drains blood and fluids/air. Restores the regular negative pressure in the pleural space. Keep below chest level because gravity will help with drainage.

Question 9

What does gentle steady bubbling mean in wet drainage system?

Answer 9

It has a good suction rate.

Question 10

What should be next to the beside in case of accidental disconnection?

Answer 10

Sterile water to put tube end so air can come out but not in, and gauze/air tight tape in case you need to put it over insertion site (tape 3 sides so air can go out one side).

Question 11

What secures the connection between patient/drainage unit?

Answer 11

Tape and zip ties

Question 12

How long can clamp a chest tube for/what do assess for and why?

Answer 12

For less than 1 minute. To change drainage unit, locate air leaks (clamp and listen), assess bubbling and fluctuation. It will cause tension pneumothorax

Question 13

How to confirm placement?

Answer 13

Use chest x-ray

Question 14

What is subcutaneous emphysema?

Answer 14

Means there is an air leak. Air gets into the tissues under the skin (subcutaneous tissues)

Question 15

What to assess for chest tubes? S+S, appearance, tubing

Answer 15

Inspect- how they look, distressed/calm, blue, SOB, vital signs
Resp and O2 status (auscultate chest, LOC, ABGs, SPO2, respiratory effort). Pain level, chest tube insertion site (dry, intact, bleeding, subcutaneous emphysema). S+S (hypotension, tachycardia).

Tubing- should be no kinks, clots (want it patent and free draining)

Question 16

Complications of chest tube?

Answer 16

Obtruded or displaced chest tube can cause tension pneumothorax. Infection at insertion site, pneumonia.

Question 17

Why do you never milk or strip the chest tube?

Answer 17

Can lead to lung collapse

Question 18

What is a PICC?

Answer 18

Peripherally inserted central catheter. Put into by percutaneous insertion. Usually in the basilic or cephalic vein/threaded through the subclavian vein into superior vena cava.

Question 19

True or false- we don’t draw blood/do blood pressure on this arm where they have an IV

Answer 19

True

Question 20

What is a nontunneled CVC?

Answer 20

Inserted into internal jugular or subclavian vein. Secured through sutures. Associated with higher risk of infection/greater complications. Need placement confirmation before use.

Question 21

What is a tunnelled catheter?

Answer 21

Has a cuff that tissue grows into to prevent movement of CVC. The cuff has antibiotics in them. Used for long term when PICC isn’t appropriate.

Question 22

What is an implanted port?

Answer 22

Silicone catheter attached to a port that has self sealing septum for needle access. Port is implanted centrally or peripherally, Patient can mange it at home with equipment.

Question 23

What to assess site for?

Answer 23

Redness/swelling/leakage/phlebitis. S+S of infection- pus. Sutures (dry and intact)/dressing secure.

Question 24

How often to change dressing site?

Answer 24

Dressing change every 5-7 days/PRN when soiled/wet.

Question 25

How often do you change needless adapters?

Answer 25

Change every 7 days

Question 26

How long to change tubing/extension sets?

Answer 26

Changed every 96 hrs

Question 27

What do you cleanse needless adapters with?

Answer 27

15 seconds with alcohol swab

Question 28

How do you assess CVC or PICCs before giving medication or infusions?

Answer 28

Aspirate for blood return prior to each use of medication or infusions.

Question 29

How to flush for PICCs and when?

Answer 29

Flush with 0.9% sodium chloride using start/stop flush technique. Do it after blood withdrawal, before/after med administration, and maintenance of unused lumen.

Question 30

How to remove PICC and CVC?

Answer 30

PICC- extend arm out at 90 degrees and don’t manipulate arm above site, apply pressure for 5 min

CVC- remove and pull on exhalation, apply occlusive dressing and check tip intactness

Question 31

Some complications of CVADs?

Answer 31

Infection, air embolism, VTE, catheter occlusion, displacement of catheter, phlebitis, extravasation, pneumo and hemothorax (especially during insertion).

Question 32

What to do after chest tube insertion? position in bed

Answer 32

Order x ray, place patient in semi fowlers to evacuate air, or high fowlers to drain fluid?

Question 33

How to insert short PIVC?

Answer 33

1- tourniquet upper arm 10 cm above site
2- select vein by inspecting/palpating- 3 finger above wrist
3- remove tourniquet, gloves, reapply tourniquet, clean site with CHG for 30 seconds
4- stabilize vein with NDH/pull skin taut, puncture bevel up 10-15 degrees, look for blood return then lower angle and advocate further while push off tab
5- attach add ones, sterile dressings, flush and observe for swelling, close clamps

Question 34

What is a water seal?

Answer 34

One way valve to prevent air/liquid from moving back to chest cavity.

Question 35

What is tidaling?

Answer 35

Normal thing of when water in chamber rises during inhaling and falls during exhaling.