Management of Closed Chest Drainage System Flashcards
The Dressing of a Closed Chest Drainage System must be kept how ?
Tight & Intact
With a closed Chest Drainage System what should you listen for ?
Breath sounds in both lungs (compare lungs) & monitor for breathing difficulty
With a closed Chest Drainage System you want to monitor the PoX and report a reading of what ?
Anything < 90%
With a closed Chest Drainage System, what do you want to palpate the chest tube insertion site for ? and why ?
Subcutaneous emphysema
as this could indicate poor tube placement
With a closed Chest Drainage System, how often should you record chest drainage for in the first 24 hours ?
Every hour
With a closed Chest Drainage System, how often should you record the chest drainage after the first 24 hours ?
Every 8 hours
With a closed Chest Drainage System, what things should require notifying the primary healthcare provider ?
- 200mL of drainage or greater in one hour
- 100mL or greater any hour after the 1st hour
- Change in color (like yellow, to bright red)
With a closed Chest Drainage System, should a client deep breathe, cough, and use incentive spirometer ?
Yes
??? (page 162) ???
What things do you want to watch for in a client, d/t the possibility of developing an infection at the insertion site ?
- Fever
- Increased WBC’s
- Drainage (increased???). (page 162)
Why do you want to watch daily x-rays in a client With a closed Chest Drainage System ?
For re-expansion
NCLEX QUESTION
A PHP prescribed an analysis of chest drainage for WBC’s. Where would you obtain the specimen ?
- Drainage collection chamber (No, b/c it has been harboring bacteria)
- CHEST TUBE :) (use needle to stick into tubing)
Where do you want to keep the CDU ?
Below the level of the chest
Why DONT you want the CDU to be above chest level ?
B/c if you lift to high, fluids or air will go back into the pleural space
What do we want to promote with CDU’s ?
Gravity drainage
How do you want to keep the tubing of a CDU ?
Straight & free of kinks, and dependent loops
CDU’s must be a closed system, therefore what should you do ?
Tape all connections!
True or False:
You should monitor the water levels in the system ?
True
With a CDU, what do you want to see with respirations ?
Tidaling (fluctuations)
Tidaling (fluctuations) will stop when ?
When the lung has re-expanded, or if there is a kink/clot in the tubing, or a dependent loop is present in the system
What does continuous bubbling in the water seal chamber mean ?
You have an air leak in the system
Never clamp a chest tube without what ?
A prescription
What could clamping a chest tube lead to ?
a Tension Pneumothorax
this is why you need a Dr. prescription to clamp a chest tube
What should you do if the tubing becomes disconnected ?
- Keep another fresh sterile connector at the bedside
- Re-connect as fast as you can (b/c don’t want air going in)
What should you do if the CDU falls over and the water leaks out OR shifts to the drainage compartment ?
- Do whatever you can to re-connect the water seal
- Set CDU upright, check all the chambers, and fill the water seal chamber to 2cm of water
- Have the client deep breathe and cough (in case any air went into the pleural space, B/c air can collapse the lung)
- if there is no water in the water seal chamber, then air can collapse the lung
If there is no water in the water seal chamber, then air can do what ?
Collapse the lung
What should you do if the chest tube is accidentally pulled out ? and why ?
Put a Sterile Occlusive dressing taped down on 3 sides
(could also put a gloved hand over the hole until you have the dressing)
Why: B/c otherwise every time the client takes a deep breath, they will pull air into the pleural space
What is the protocol for Chest Tube removal ?
- Have the client take and deep breath and hold (or valsalva)
& - Place an occlusive dressing over the site
