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NRSG 227 > chest tubes and traces > Flashcards

chest tubes and traces Flashcards

1
Q

what are some signs of airway obstruction due to swelling in the neck?

A
  • Use accessory muscles to breathe
  • Suprasternal and intercostal retractions
  • Stridor
  • Wheezing
  • Restlessness
  • Tachycardia
  • Cyanosis
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2
Q

describe an endotracheal (ETT)

A
  • Don’t require incision
  • Quick insertion
  • used for short term mechanical ventilation
  • Useful for administering inhaled gases
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3
Q

describe a tracheostomy

A
  • more invasive/ versatile
  • used for short or long term ventilation
  • permanent or temporary
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4
Q

how is a tracheostomy put in?

A
  • surgical incision made into the trachea

- creates stoma > airway managed by this

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5
Q

if a person has an underlying problem and is being treated with a tracheostomy and its corrected what could potentially happen?

A
  • removal of tube

- tracheostomy closed

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6
Q

what are the components of a cuffed tracheostomy ?

A
  • tracheostomy tube
  • inner cannula
  • obturator
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7
Q

describe the inner cannula of the cuffed tracheostomy

A
  • smaller tube that fits into the tracheostomy
  • can be removed easily to get gummed up respiratory secretions out
  • usually disposable
  • replaced every day or more often if client has thick secretions
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8
Q

describe the obturator of the cuffed tracheostomy

A
  • used to insert tracheostomy then removed

- kept at beside

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9
Q

describe the cuff on the cuffed tracheostomy

A
  • connected to a little tube and port where syringe can be attached
  • uses a luer lock connection > used to fill the cuff with air > no air can flow past tracheostomy tube once in client
  • has a pilot light
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10
Q

what is a pilot light in a cuffed tracheostomy?

A
  • located close to where syringe is attached
  • small balloon
  • when inflated means cuff is filled
  • when deflated means cuff is deflated
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11
Q

what does a pilot light on a cuffed tracheostomy tell a healthcare worker?

A

whether tracheostomy cuff is inflated or not just by looking at it

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12
Q

describe a laryngectomy

A
  • surgical removal of larynx (contains vocal cords)
  • can look like tracheostomy from outside
  • end of trachea sutured to edges of stoma > once healed plastic tube may not be needed
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13
Q

when is a laryngectomy performed?

A

when person had advanced cancer of the larynx that can’t be managed by a more conservative treatment

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14
Q

Why is it important to now if someone has a laryngectomy if you have to give CPR?

A
  • airway is completely separated from mouth, nose and esophagus
  • need to ventilate through stoma in neck
  • use smaller paediatric bag valve mask
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15
Q

What additional safety equipment is needed at the bedside when a client has a new tracheostomy?

A
  • replacement trach tube
  • obturator
  • spare inner cannula
  • suction supplies
  • spare trach ties/ trach collar
  • equipment to replace trach tube if dislodged
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16
Q

when a client has a new tracheostomy, what safety equipment needs to be close by and not necessarily right at bedside?

A

manual resuscitation device (proper size/ mask)

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17
Q

what are the clinical manifestations of respiratory failure?

A
  • increased RR
  • increased work of breathing
  • use of accessory muscles to breathe
  • decreased oxygen saturation
  • cyanosis
  • anxiety
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18
Q

What are clinical manifestations of bleeding at the tracheostomy site?

A
  • noticeable bleeding > caused by elevated BP or coughing
  • decreased BP
  • blood in respiratory secretions
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19
Q

what are the clinical manifestations of infection at the tracheostomy site?

A
  • increased pain
  • swelling
  • redness
  • exudate
  • increased drainage
  • elevated temp
  • chills
  • rigors
  • elevated WBC count
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20
Q

what are the clinical manifestations of a pneumothorax ?

A
  • decreased breath sounds or decreased air entry in 1 or both of lung fields
  • chest pain
  • dyspnea
  • elevated RR
  • decreased oxygen saturation
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21
Q

What is subcutaneous emphysema?

A

air leaks into subcutaneous tissues around tracheostomy

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22
Q

What are clinical manifestations of subcutaneous emphysema?

A
  • swelling of the neck
  • extending up into the jaw or down into chest
  • on palpation tissue feels crackly
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23
Q

what are the long term complications of having a tracheostomy?

A
  • tracheal stenosis
  • tracheomalacia
  • granuloma formation
  • tracheoesophageal fistula
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24
Q

in regards to long term complications of having a tracheostomy, describe a tracheal stenosis

A
  • narrowing of the trachea

- caused by irritation at the trach site from cuff being inflated to much

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25
Q

in regards to long term complications of having a tracheostomy, describe a tracheomalacia

A
  1. trachea becomes weak/ flaccid

2 structure of trach changes

  • collapse during high flow
  • coughing, crying, eating
  1. caused by poorly fitted tube
    - damages tracheal tissues
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26
Q

in regards to long term complications of having a tracheostomy, describe a granuloma formation

A
  • hyper granulation tissue grows at trach site > may occur distal to site inside trach
  • hyper granulation tissue friable/ bleeds easily
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27
Q

in regards to long term complications of having a tracheostomy, what causes a granuloma formation?

A
  • ill-fitting tube

- chronic inflammation/ infection

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28
Q

in regards to long term complications of having a tracheostomy, describe tracheoesophageal fistula

A
  • fistula between esophagus and trachea

- gastric content can enter resp tract and air can enter stomach > cause pneumonia and abdominal distension

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29
Q

what is a fistula?

A

abnormal connection between 2 different parts of the body

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30
Q

What causes a tracheosophageal fistula?

A
  • friction between cuff of trach tube and nasogastric tube in esophagus
  • injury > when trach was originally created
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31
Q

How often does a trach need to be cared for?

A
  • twice a day or more frequent if needed
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32
Q

What does routine tracheostomy care entail?

A
  • changing trach dressing if soiled/ wet
  • changing trach ties if soiled/ wet
  • cleansing around trach site with sterile saline
  • changing/ cleansing inner cannula
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33
Q

What type of trach has a reusable inner cannula?

A

cuff less tracheostomy

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34
Q

How often do inner cannulas need to be cleaned?

A
  • check for patency every 12hrs
  • disposable inner cannula > changed every 24hrs
  • non-disposable inner cannulas > cleaned every 24hrs
35
Q

what do you do in the case of accidental decannulation?

A
  • do not replace tube
  • assess ABCs
  • stay with patient
  • ask someone to cal RT STAT and call doctor
  • if client can’t breathe maintain satisfactory O2STAT and call code blue
36
Q

What is the process of weaning a patient off of a tracheostomy?

A
  • takes about 2-7 days
  • deflate trach cuff
  • replacing cuff tube with a smaller uncured tube
  • capping/ corking trach tube
  • removing (decannulating) trach tube
37
Q

in regards to the process of weaning a patient off of a tracheostomy describe replacing cuffed tube with a smaller uncuffed tube

A
  • client should maintain adequate breathing and oxygenation

- client is breathing through trach and mouth/nose

38
Q

in regards to the process of weaning a patient off of a tracheostomy describe capping/ corking the trach tube

A
  • cap that covers opening in trach tube
  • client is only breathing through mouth/nose
  • if client feels SOB and O2STAT drops remove cap> allows client to breath through trach again
39
Q

in regards to the process of weaning a patient off of a tracheostomy describe removing (decannulating) trach tube

A
  • tube is removed
  • stoma covered with sterile folded gauze/ tape
  • stoma starts to heal/ permanently close
40
Q

describe ches tubes

A
  • drainage tubes used to remove air/ fluid from chest cavity
  • usually placed in pleural space
  • if needed > placed into mediastinal space (around heart)
41
Q

What are indications for chest tubes?

A
  • pneumothorax
  • pleural effusion
  • hemothorax
  • empyema
  • chylothorax
  • thoracic or chest surgery
42
Q

in regards to chest tubes, describe a pneumothorax

A
  • air in pleural space

- mainly air and some pleural fluid coming out

43
Q

in regards to chest tubes, describe a pleural effusion

A
  • fluid in the pleural space
  • yellow or amber
  • clear or cloudy
44
Q

in regards to chest tubes, describe a hemothorax

A
  • blood in pleural space
  • caused by trauma
  • blood draining from chest tube
45
Q

in regards to chest tubes, describe empyemma

A
  • pus or purulent drainage builds up in pleural space
  • caused by condition > pneumonia or lung abscess
  • drainage from chest tube would appear purulent
46
Q

in regards to chest tubes, describe a chylothorax

A
  • lymphatic fluid leaks into pleural space
  • due to trauma or complication of chest surgery
  • chest tube drainage appears milky white
47
Q

in regards to chest tubes, describe a thoracic or chest surgery

A
  • surgery of heart or lungs
  • tubes placed after surgery in the pleural or mediastinal space to drain air, blood, or serous fluid resulting from surgery
48
Q

What can cause a pleural effusion

A
  • to much hydrostatic pressure in blood vessels
  • not enough plasma proteins (albumin) in blood stream
  • inflammatory or infectious process in lungs
49
Q

in regards to a pleural effusion describe to much hydrostatic pressure in blood vessels

A
  • forces fluid to be pushed out of blood vessels into pleural space
  • happens in HF especially left sided
50
Q

in regards to a pleural effusion describe not enough plasma proteins (albumin) in blood stream

A
  • helps maintain plasma oncotic pressure
  • not enough cause fluid to leak out of blood vessels
  • happens when person is malnourished, or liver failure
51
Q

in regards to a pleural effusion describe inflammatory or infectious process in lungs

A
  • produces exudate

- can be caused by pulmonary emboli, lung infections, lung cancer

52
Q

describe a thoracotomy

A
  • chest open to perform surgery on lungs
  • used when person has lung cancer > all or part of lung removed
  • chest tubes placed at bottom of lung
  • incision curves with rib
53
Q

describe pigtail drains

A

small- bore chest tube

  • curled end
  • smaller in diamater
  • less painful than some larger diameter tubes
  • used to drain air and pleural fluid
  • thick fluid can clog pigtail
54
Q

describe tension pneumothorax

A
  • build up of air in pleural space
  • every breath causing increased pressure in pleural space
  • compresses affected lung, airways and blood vessels
  • if not treated ASAP can prevent heart from filling/ pumping/ cause both lungs to collapse
    caused from kinked chest tube
55
Q

What does a tension pneumothorax result in?

A

structures being shoved to opposite side of chest

56
Q

describe an atrium oasis closed drainage system with water seal drain

A
  • used after trauma or surgery

- has 3 compartments

57
Q

what are the compartments of the atrium oasis closed drainage system wit water seal drain?

A
  • one chamber that collects drainage
  • one chamber with a water seal > allows air to escape from chest tube but doesn’t allow air to get back in
  • suction control chamber that allows nurse to regulate amount of suction that’s applied the chest tube
58
Q

describe a pneumostat chest drain valve

A
  • one way valve
  • has a very small collection chamber
  • only used when physician doesn’t anticipate much drainage
  • can’t be attached to suction
  • small/ portable > makes mobilizing easier
59
Q

What types of cancers are malignant pleural effusion associated with?

A
  • lung
  • breast
  • leukemia
  • lymphoma
60
Q

describe malignant pleural effusions

A
  • most common in last 4-6 months of life
  • inflammation around cancer causes fluid to build up in pleural space
  • cancer can prevent normal drainage of pleural fluid
61
Q

When is a PleurX chest drain used?

A

when a client has chronic condition that continuously causes fluid to build in chest > needs to be drained periodically

62
Q

What does a PleurX chest drain look like?

A
  • tunneled indwelling pleural catheter with intermittent drainage
  • chest tube is meant to stay in place for long time
  • egg shaped drain sealed to maintain vacuum until punctured by T-plunger
63
Q

how do clients use a Pleura chest drain?

A
  • fluid builds up in pleural space and starts causing pain/ difficulty breathing
  • drain connected to PleurX catheter and fluid drains
  • when drainage is done catheter is disconnected from drain and catheter is coiled up on client’s chest/ covered with sterile dressing until needed again
64
Q

Who is a pleurX chest drain meant for?

A

people living in community who need chest tube

65
Q

What is included in a chest tube drainage system assessment?

A
  • respiratory assessment
  • assess for subcutaneous emphysema
  • check dressing
  • check tubing: eliminate dependent loops
  • check tubing: connection are taped
  • follow tubing to wall suction (if ordered)
  • assess amount and type of drainage
  • assess bubbling in the water seal chamber
  • assess for tidying (fluctuating)
  • check water level in the water seal chamber
  • check amount of suction matches doctor order
  • check drainage system is secured (prevent tipping)
66
Q

in regards to the assessment for a chest tube drainage system, describe respiratory assessment

A
  • trachea is midline
  • chest expansion is symmetrical
  • lung auscultation
  • air entry > may be decreased if lung partially collapsed
67
Q

in regards to the assessment for a chest tube drainage system, describe assess for subcutaneous emphysema

A
  • air leaks out through tissues around chest tube into subcutaneous tissues
  • observe/ palpate for swelling and crepitus (crunching sensation) in tissues around chest tube
68
Q

in regards to the assessment for a chest tube drainage system, describe chef tubing: eliminate dependent loops

A

check tubing from chest tube to drainage system/ eliminate any loops

69
Q

in regards to the assessment for a chest tube drainage system, describe follow tubing to wall suction

A
  • follow suction tubing from drainage system to wall suction

- wall suction needs to be strong enough to activate suction in the drainage container (around 80mmHg)

70
Q

in regards to the assessment for a chest tube drainage system, describe assess amount and type of drainage

A
  • should be light yellow, straw coloured fluid
  • some blood is fine
  • record amount of drainage
71
Q

in regards to the assessment for a chest tube drainage system, describe assess bubbling in the water seal chamber

A
  • get client to take deep breath and blow out

- if air leak in client or system will cause bubbles to escaper through water seal chamber

72
Q

in regards to the assessment for a chest tube drainage system, describe assess for tidalling (fluctuating)

A
  • level of fluid is fluctuating up/ down as they breathe
  • any fluid in tubing of drainage system will fluctuate as well
  • indicates changing pressures in pleural space
73
Q

in regards to assessing tidalling (fluctuating) explain what happens with a collapsed lung when it re-expands

A
  • fluctuations should become less and less

- once client is healed/ close to nurse shouldn’t be able to see any tidalling when client takes deep breath

74
Q

in regards to the assessment for a chest tube drainage system, describe check water level in the water seal chamber

A
  • should be right at 0 mark
  • water can evaporate if client has chest tube drainage system for long time > bubbling causes this
  • water to low/ high nurse can adjust with sterile water
75
Q

in regards to the assessment for a chest tube drainage system, describe check amount of suction matches doctor order

A
  • suction ordered nurse sets specific suction on front of drainage system
76
Q

in regards to the assessment for a chest tube drainage system what happens if suction is greater or less than 20cm?

A
  • suction > 20cm red bellow expand across window
  • suction <20cm not strong enough to pull red bellows all the way across > should still be ablate see
  • no suction ordered nurse should disconnect system from wall suction
77
Q

in regards to the assessment for a chest tube drainage system, describe check drainage system is secured (prevent tipping)

A
  • ensure bellow chest tube site
  • can be taped to floor > not normally done
  • normally taped to bottom of IV pole > make mobilizing easier for patient
78
Q

in regards to the assessment for a chest tube drainage system, what happens if drainage system falls over?

A
  • stand upright

- tilt over to right side > get drained fluid back into correct columns

79
Q

describe an air leak in a client with a chest tube

A
  • air is escaping out from the chest tube drainage system through water seal chamber
  • will look like bubbles
80
Q

what can cause an air leak in a client with a chest tube?

A
  • break/ crack in collection devise
  • crack/ break or disconnection in tubing
  • inside client (pneumothorax)
81
Q

nursing education to promote health and avoid complications with chest tubes

A
  • adequate nutrition
  • staying hydrated
  • managing pain effectively
  • monitor for signs of infection
  • changing positions frequently to prevent skin breakdown
82
Q

What do you do if a chest tube is pulled out?

A
  • put on clean gloves/ cover site with gloved hand
  • call for help
  • have assistant get non-adherent dressing (mepitel), 4X4 gauze and tape
  • apply dressing over site, cover with gauze, tape on 3 sides > creates 1 way valve
  • once dressing in place, one nurse stay with client to ensure they don’t go into distress, other nurse calls doctor ASAP/ reports
83
Q

describe toothless Kelly clamps in regards to chest tubes

A
  • always have 2 at bedside

- used when looking for air leak

84
Q

What might the doctor get the nurse to do with Kelly clamps if they’re thinking about removing chest tube?

A
  • get nurse to clamp tubing overnight or longer

- if client can stand this chest X-ray ordered to see lungs remaining fully expanded/ underlying problem resolved

NRSG 227 (3 decks)

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