Chest Tubes (The first 28 Questions are AI Generated) Flashcards
True or False: Chest tubes are used to remove air, blood, or fluid from the pleural space.
True
What is the purpose of a water seal chamber in a chest tube setup?
To prevent air from re-entering the pleural space during inspiration
Between a Wet Chest Tube and a Dry Chest Tube, which one should have constant bubbling? Or should it be both?
Just the Wet Chest Tube
What is the normal range for water in the water seal chamber of a chest tube setup?
2 cm
What should be done if the chest tube becomes disconnected from the drainage system?
Clamp the tube and immediately notify the healthcare provider
What position should the patient be in when a chest tube is being inserted?
Sitting upright or in a high Fowler’s position
What should the nurse assess for immediately after a chest tube insertion?
Breath sounds and respiratory distress
What is the purpose of a Heimlich valve in a chest tube setup?
To prevent air from entering the chest cavity during exhalation
What is the recommended frequency for assessing the chest tube drainage system?
Hourly
What can be done to alleviate pain and discomfort at the chest tube insertion site?
Applying a sterile occlusive dressing
What position should the chest tube drainage system be kept in?
Below the level of the patient’s chest
What should the nurse do if there is no fluctuation in the water seal chamber?
Check for kinks or obstructions in the tubing
What is the primary complication associated with chest tubes?
Pneumothorax
What is the purpose of applying suction to a chest tube?
To promote drainage of air or fluid from the pleural space
What should the nurse do if there is sudden and excessive bubbling in the water seal chamber?
Assess for a leak in the system
What is the recommended method for securing a chest tube to the patient?
With an occlusive dressing and sutures
What is the appropriate action if the chest tube accidentally becomes dislodged?
Cover the site with a sterile occlusive dressing and notify the healthcare provider
What is the purpose of a chest tube stripping or milking procedure?
To facilitate drainage of clotted blood or fluid in the tubing
What should the nurse do if the chest tube drainage suddenly stops?
Check for kinks or obstructions in the tubing
What is the most common complication of chest tube insertion?
Subcutaneous emphysema
What should the nurse do if there is continuous bubbling in the water seal chamber?
Check for air leaks in the system
What is the recommended method for measuring chest tube drainage?
Using a calibrated drainage collection chamber
What should the nurse do if the chest tube drainage exceeds 100 mL/hr?
Notify the healthcare provider immediately
What is the purpose of a flutter valve in a chest tube setup?
To allow air to escape from the pleural space without allowing air to re-enter
What is the appropriate action if the chest tube becomes accidentally pulled out?
Cover the site with a sterile occlusive dressing and notify the healthcare provider
What is the primary goal of chest tube management?
To restore negative pressure in the pleural space
What should the nurse do if the chest tube accidentally disconnects from the drainage system?
Clamp the tube and immediately reconnect to the drainage system
What is the expected assessment finding immediately after chest tube insertion?
Initial bubbling in the water seal chamber
Where should a chest tube end up after insertion? Why?
The Pleural Space (To drain fluid or air from the chest)
What’re the other names for a Chest Tube?
Chest Drain
Thoracic Catheter
Thoracostomy Drain
Intercostal Drain
What is a Pneumothorax?
Partial to Complete Collapse of the Lung due to Air Accumulation in the Pleural Space
What is a Hemothorax?
Partial to Complete Collapse of the Lung due to Blood Accumulation in the Pleural Space
What does Pleural Effusion mean?
Abnormal accumulation of Fluid in the Pleural Space
What is Pulmonary Empysema
Accumulation of Pus in the Pleural Space
What can Pleural Empysema be caused by?
Pulmonary Infection + Lung Abscess + Infected Pleural Effusion
Why might a Chest Tube be important Post-Operatively?
Postoperative Chest Drainage
What are the manifestations of having fluid, air, or pus in the pleural space?
Dyspnea + Distended Neck Veins + Hemodynamic Instability + Pleuritic Chest Pain + Cough + Asymmetrical Chest Wall Motion
Absent / Reduced Breath Sounds on the Affected Side (Pneumothorax)
Dullness / Flatness on Percussion of the Affected Side (Hemothorax or Pleural Effusion)
How should a pt with fluid, air, blood, or pus in their pleural space be positioned?
High Fowler’s (To Lower Their Diaphragm & Reduce Risk of Injury)
How should a pt who’s getting a Chest Tube inserted be positioned?
Position them with the arm on their affected side raised above their head (Because it exposes the Midaxillary Area)
What kind of Anesthetic is used for Chest Tube insertion?
Local Anesthetic
How is Chest Tube placement confirmed?
Chest X-Ray
What does the Chest Tube size depend on?
The reason for the Chest Tube
What size chest tube is required for Hemothorax?
Large Tubes (36 - 40 F)
What size chest tube is required for Pleural Effusion or Pulmonary Empyema?
Medium (24 - 36 F)
What size chest tube is required for a Pneumothorax if the patient is tall, has a bunch of muscle, or obese?
Small (12 - 24 F)
What size chest tube is required for a Pneumothorax if the patient is average or small sized?
Very Small (10 - 14 F), the curly end is designed to stay in place
The standard Wet and Dry drainage systems should be set to what water height?
-20
In order to ensure that the air leak monitor of a Wet or Dry Chest Tube is filled, the water should be filled to the-
2 cm Line
The Air Leak Monitor of a Wet or Dry Chest Tube will show the severity Air Leak, this will be on a scale of-
1 (Less Severe) to 5 (Most Severe)
What is Tidaling?
Movement of the fluid level with Respiration
What does a Wet Chest Tube used to suction?
Gravity
Does a Dry Chest Tube use gravity to suction like a Wet Chest Tube does?
No
Should a Wet Chest Tube be held above or below the pt’s chest?
Below
Should a Dry Chest Tube be kept above or below the pt’s chest?
Below
What’s the difference between a Heinrich Valve and a Chest Tube?
It’s used in place of a Chest Drainage System for a Small, Uncomplicated Pneumothorax
What’s important to keep in mind about a Heimlich Valve (Flutter Valve)?
It can be hid under clothing. Pt’s can be sent home with this valve in place
How many minutes should a pt be medicated before a Chest Tube Insertion?
30 mins
After a Chest Tube Insertion, what needs to be inspected for at the Insertion Site?
Subcutaneous Emphysema
What needs to be done after Chest Tube Insertion?
Range Of Motion (ROM) Exercises to the Shoulder & Affected Site.
Encourage use of ICS.
Have pt Breathe Deeply Periodically (in order to promote Lung Expansion).
For Chest Tube Drainage, when should a Provider be notified?
If Drainage is >100 mL/hr
The Collection Chamber of a Chest Tube is full. What do you do?
Replace the Collection Chamber, DON’T EMPTY IT
What should you never do to Chest Tubing?
Never Compress, Milk, or Strip Chest Tubing
How often should a Chest Tube’s Dressing be changed?
Every 7 Days, if Soiled change ASAP
A pt has a Chest Tube in, the fluid in the Chest Tube isn’t Rising or Falling when the breathe in and out.
What may be going on?
The Drainage System may be Blocked.
The Lungs may have Re-Expanded.
When should a System Leak be expected for pt’s with a Chest Tube?
When Bubbling is Continuous
A System Leak is suspected for a pt with a Chest Tube, what needs to be done?
Retake the Tubing Connections
The the pt’s Chest Tube is disconnected, what needs to be done?
Place it into a container of Sterile Water as an Emergency Seal
When removing a Chest Tube, the Suction is discontinued but the Chest Tube is allowed to drain via Gravity.
How long is this allowed to happen for?
24 hrs
When should Analgesics be administered before Chest Tube removal?
30-60 mins
Whenever the Chest Tube insertion site is covered with an Airtight, Occlusive Dressing, how long will it take for the wound to heal and for the Pleura to close off?
In a Few Days
After a Chest Tube Removal, why is a Chest-X Ray required? When should it be done?
Should be done after ~1 hr (To check for a Pneumothorax or Fluid Re-Accumulation)
