Chest Tubes and Central Venous Devices Flashcards
What is pneumothorax?
Acculturation of air in pleural cavity that leads to partial/complete lung collapse.
What is hemothorax?
Collection of blood in pleural space. Buildup of blood can cause lung to collapses
What is pneumohemothorax?
When air and blood enter pleural cavity
What is empyema?
Build up of pus in pleural cavity
What is spontaneous pneumothorax?
Can occur in patients with COPD who have a burst bleb that causes air leak into the pleural space
Where to place chest tube for air?
Anterior through 2nd intercostal space because air is lighter then blood.
Where to place chest tube for blood/fluid?
Posterior through the 8/9 intercostal space.
What does the chest tube do and where to put it?
Drains blood and fluids/air. Restores the regular negative pressure in the pleural space. Keep below chest level because gravity will help with drainage.
What does gentle steady bubbling mean in wet drainage system?
It has a good suction rate.
What should be next to the beside in case of accidental disconnection?
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).
What secures the connection between patient/drainage unit?
Tape and zip ties
How long can clamp a chest tube for/what do assess for and why?
For less than 1 minute. To change drainage unit, locate air leaks (clamp and listen), assess bubbling and fluctuation. It will cause tension pneumothorax
How to confirm placement?
Use chest x-ray
What is subcutaneous emphysema?
Means there is an air leak. Air gets into the tissues under the skin (subcutaneous tissues)
What to assess for chest tubes? S+S, appearance, tubing
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)
Complications of chest tube?
Obtruded or displaced chest tube can cause tension pneumothorax. Infection at insertion site, pneumonia.
Why do you never milk or strip the chest tube?
Can lead to lung collapse
What is a PICC?
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.
True or false- we don’t draw blood/do blood pressure on this arm where they have an IV
True
What is a nontunneled CVC?
Inserted into internal jugular or subclavian vein. Secured through sutures. Associated with higher risk of infection/greater complications. Need placement confirmation before use.
What is a tunnelled catheter?
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.
What is an implanted port?
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.
What to assess site for?
Redness/swelling/leakage/phlebitis. S+S of infection- pus. Sutures (dry and intact)/dressing secure.
How often to change dressing site?
Dressing change every 5-7 days/PRN when soiled/wet.
How often do you change needless adapters?
Change every 7 days
How long to change tubing/extension sets?
Changed every 96 hrs
What do you cleanse needless adapters with?
15 seconds with alcohol swab
How do you assess CVC or PICCs before giving medication or infusions?
Aspirate for blood return prior to each use of medication or infusions.
How to flush for PICCs and when?
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.
How to remove PICC and CVC?
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
Some complications of CVADs?
Infection, air embolism, VTE, catheter occlusion, displacement of catheter, phlebitis, extravasation, pneumo and hemothorax (especially during insertion).
What to do after chest tube insertion? position in bed
Order x ray, place patient in semi fowlers to evacuate air, or high fowlers to drain fluid?
How to insert short PIVC?
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
What is a water seal?
One way valve to prevent air/liquid from moving back to chest cavity.
What is tidaling?
Normal thing of when water in chamber rises during inhaling and falls during exhaling.
