Management of Closed Chest Drainage System

Question 1

The Dressing of a Closed Chest Drainage System must be kept how ?

Answer 1

Tight & Intact

Question 2

With a closed Chest Drainage System what should you listen for ?

Answer 2

Breath sounds in both lungs (compare lungs) & monitor for breathing difficulty

Question 3

With a closed Chest Drainage System you want to monitor the PoX and report a reading of what ?

Answer 3

Anything < 90%

Question 4

With a closed Chest Drainage System, what do you want to palpate the chest tube insertion site for ? and why ?

Answer 4

Subcutaneous emphysema

as this could indicate poor tube placement

Question 5

With a closed Chest Drainage System, how often should you record chest drainage for in the first 24 hours ?

Answer 5

Every hour

Question 6

With a closed Chest Drainage System, how often should you record the chest drainage after the first 24 hours ?

Answer 6

Every 8 hours

Question 7

With a closed Chest Drainage System, what things should require notifying the primary healthcare provider ?

Answer 7

• 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)

Question 8

With a closed Chest Drainage System, should a client deep breathe, cough, and use incentive spirometer ?

Answer 8

Yes

??? (page 162) ???

Question 9

What things do you want to watch for in a client, d/t the possibility of developing an infection at the insertion site ?

Answer 9

• Fever
• Increased WBC’s
• Drainage (increased???). (page 162)

Question 10

Why do you want to watch daily x-rays in a client With a closed Chest Drainage System ?

Answer 10

For re-expansion

Question 11

NCLEX QUESTION

A PHP prescribed an analysis of chest drainage for WBC’s. Where would you obtain the specimen ?

Answer 11

1. Drainage collection chamber (No, b/c it has been harboring bacteria)
2. CHEST TUBE :) (use needle to stick into tubing)

Question 12

Where do you want to keep the CDU ?

Answer 12

Below the level of the chest

Question 13

Why DONT you want the CDU to be above chest level ?

Answer 13

B/c if you lift to high, fluids or air will go back into the pleural space

Question 14

What do we want to promote with CDU’s ?

Answer 14

Gravity drainage

Question 15

How do you want to keep the tubing of a CDU ?

Answer 15

Straight & free of kinks, and dependent loops

Question 16

CDU’s must be a closed system, therefore what should you do ?

Answer 16

Tape all connections!

Question 17

True or False:

You should monitor the water levels in the system ?

Answer 17

True

Question 18

With a CDU, what do you want to see with respirations ?

Answer 18

Tidaling (fluctuations)

Question 19

Tidaling (fluctuations) will stop when ?

Answer 19

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

Question 20

What does continuous bubbling in the water seal chamber mean ?

Answer 20

You have an air leak in the system

Question 21

Never clamp a chest tube without what ?

Answer 21

A prescription

Question 22

What could clamping a chest tube lead to ?

Answer 22

a Tension Pneumothorax

this is why you need a Dr. prescription to clamp a chest tube

Question 23

What should you do if the tubing becomes disconnected ?

Answer 23

• Keep another fresh sterile connector at the bedside

- Re-connect as fast as you can (b/c don’t want air going in)

Question 24

What should you do if the CDU falls over and the water leaks out OR shifts to the drainage compartment ?

Answer 24

• 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

Question 25

If there is no water in the water seal chamber, then air can do what ?

Answer 25

Collapse the lung

Question 26

What should you do if the chest tube is accidentally pulled out ? and why ?

Answer 26

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

Question 27

What is the protocol for Chest Tube removal ?

Answer 27

• Have the client take and deep breath and hold (or valsalva)
  &
• Place an occlusive dressing over the site