Nsg: Chest Tubes Flashcards
Purpose of a Chest Tube
Restores the negative pressure in the pleural space by draining the excesss fluid/air in the cavity.
Commonly inserted to resolve:
- Pneumothorax: Air
- Hemothorax: Blood
- Empyema: Puss
- Pleural Effusion: Fluid
What is the Pleural Space?
The space around the lungs.
Normally, there is negative pressure b/w the parital and viceral pleura.
This space and negative pressure keep the lungs expanded and allows normal inhalation and exhalation.
Any extra air or fluid in this space alters the pressure and could result in a collapsed lung.
Goal: Prevent collapsed lung.
Purpose of the Chest Drain Units (CDU)
1) To collect drainage
2) To maintain proper functioning of the chest tube
3) To prevent entry of environmental air into pleural space.
What are the three chambers of the CDU?
1) Collection Chamber:
- Allows ongoing measurement of volume. up to 2000-2500ml
2) Water Seal Chamber:
- Prevents air from entering the pleural space.
- Air can exit but cannot enter.
- Any air leaving the plerual space creating a bubbling in the water seal chamber.
- Any “Tidling” of the water volume is good. The water is moving with respirations.
- initially, any bubbling with pneumothorax will be easy to see then it will decrease.
3)Suction Control Chamber:
-Applies controlled amount of suctionn to the CDU.
Wet: Water filled w/ usually 20ml for pneumothorax.
Dry: Uses a regulator control dial to control wall suction pressure.
Care of pt with a Chest Tube
- Assess VS q2-4hrs
- Lung auscultation
- Assess occlusive drsg for areas air could enter and change as ordered
- Assess for pain
- Assess for SC emphysema
- Assess tubing connections
- Keep CDU below pt lvl
- Regular deep breathing and coughing for lung expansion q2hrs
- HOB 30degrees
- Encourage ROM of affected side to prevent “frozen shoulder”
What to assess in the collection chamber?
- Measure drainage q1hr
- Colour (serosanguinous)
- possible increase in fluid level with position change
- Report if >70ml bright red drainage
- All tubing is sterile, if there is backflow of fluid, could increase risk of infection.
What to assess in the Water Seal Chamber
-Assess lvl of water
-Assess Tidaling (fluctuations)
TIdaling shows proper functioning and patent tubes. Fluctiations correspond with respirations.
-Assess for bubbling: Expected if unresolved pneomothorax. If no pneomothorax, and theres bubbling, could indicate a leak.
What to assess in the Water Control Chamber?
Wet:
-Ensure sterile water lvl is right.
Lvl can change w/ evaporation especially w/ vigorous bubbling.
Dry:
-Ensure that regular control dial is set correctly.
How to change the CDU if needed?
Is only changed if broken or full.
- Have a new CDU ready
- Have pt hold breath
- Clamp chest tube w/ “Kelly Clamps” but not for too long b/c don’t want medial stinal shift d/t air build up
- Diconnect old + replace w/ new. (aseptic)
- Remove clamps
- Record fluids + discard.
Indications Chest Tube can be removed
Indicators that it can be removed:
- Lung sounds good in all lobed + symmetrical
- Chest xray indicates lung has expanded.
- Drainage over 24hrs = <100ml
- Decr. tidaling in Water Seal Chamber.
What to do when Removing a Chest Tube?
Done by MD or specially trained RN
- Explain procedure
- Premedicate
- D/c suction
- Remove sutures
- Pt takes deep breath “Valsalva maneuver”
- Tube is removed
- Occlusive dressing applied immediately to prevent air entry.
What is the Valsalva Maneuver?
Pt takes a deep breath + exhales while bearing down
Complications of Chest Tubes?
1) Re-expansion Pulmonary Edema:
- After rapid expansion of collapsed lungs of a pt w/ : Pneumothorax or Pleural Effusions. (Fluid drained 1-1.5L)
2) Hypotension
- B/c vasovagal respinse from too rapid removal of fluid.
3) Infection @ site
4) Pneumonia d/t decr. lung expansion from not: deep breathing, using inspirometer.
5) Frozen shoulder: from decr. ROM of affected side.
