nursing practice for chest tube Flashcards
what is pleural effusion ?
Fluid between the pleural space
what is pneumothorax ?
Air in the lungs
what to do when patient has chest tube? (nursing)
Monitor patient response
Focus on patient no equipment
Access every 2 hours for vital signs
Inspect every 8 hours for the chest tube insertion site for drainage, subcutaneous emphysema and tube migration
Always check for loose connection, can cause air to be sucked into thoracic cavity and lead to pneumothorax
what are the different parts of a water seal suction called?
- collection chamber
- water seal chamber
- air leak chamber
- suction control chamber
what to take note for collection chamber?
monitor the output and notify if there is excess output
mark the drainage level every shift with date and time
in record, record drainage colour too
what is the normal collection in chest tube with pleural effusion?
serous 20ml in 12 hour
what is abnormal drainage ?
bloody, output greater than 100ml per hour
what is considered normal in the water seal chamber?
- fluctuation as the patient breathes (5-10cm)
- intermittent bubbling ONLY when there is air in the pleural cavity
(if there is no bubble, ask patient to cough or take a deep breath. if there is no bubbling, means the pleural cavity has been sealed)
same for fluctuation, if there is no fluctuation means the negative pressure has been restored .
problem 1: wsc:
what are the possible problems when there is no fluctuation of water level in the water seal chamber ? (even after deep breathing or coughing)
- due to clot in chest tube
- dependent loop or kink
- chest drain not placed low enough
- inline connectors not properly secured
- dislodgement of catheter from patient
- dislodgement of chest tube from connector
what to do when there is dislodgement of catheter from the patient?
if there is still a air leak from the chest tube, cover site with sterile dressing and tape on 3 sides allowing air to escape (to reduce the risk of pneumothorax)
if there is no more airleak, place sterile occlusive dressing over site and monitor patient closely for signs and symptoms
what to do when there is dislodgement of chest tube from the connector ?
clamp the chest tube as close to the insertion site as possible with rubber tipped clamps, gauze wrapped kelly clamp (dangerous as no air can escape and may lead to pneumothorax)
better way is to submerge distal end of the tube in a container of sterile water to create a temporary water seal
problem 2 wsc:
What to do when there is constant bubbling in the water seal chamber?
it is probably due to air leak
what to do when there is a airleak and continuous bubbling?
momentarily clamp the chest tube close to the chest drain and observe if there is still bubbling
if the bubbling stops the air leak is from on top
what to do when there is an overfilled water seal chamber (water level above 3/4, 2cm) ?
press and hold negative pressure relief valve at the top of the chest drainage system to vent excess negative pressure in the WATER SEAL chamber
to remove water from the SUCTION control chamber, insert a syringe and withdraw the excess
what to do when there is not enough water in the water seal chamber ?
add sterile water in the WATER SEAL chamber by quickly and temporarily clamping the chest tube and injecting water to desired level
add sterile water to the SUCTION control chamber by temporarily turning off the section source removing the stopper and adding water
what are the normal sigs in the section control chamber ?
gentle bubbling
what are the nursing check to take at the suction control chamber? how to check te pressure?
detach the chamber from the suction source and when bubbling stops check the water level
add until it reaches 20 or the ordered level
what are the reasons for the suction control chamber not bubbling ?
there is possible disconnection of the suction source
what is the reason behind vigorous bubbling in the suction chamber?
there is too much suction source pressure in the system
what to do when there is vigorous bubbling in the suction chamber?
adjust the suction
what to do when there is no bubbling in the suction chamber?
ensure that the suction tubing is connected and the suction source is turned on
what to do when the chest drainage is being knocked over?
set the system upright and check the level of water in the water seal chamber and suction control chamber is correct and adjust accordingly
what to do when the patient is transported or leaving the unit ?
don’t clamp the tubing
disconnect the suction tubing from the suction source
the system will still continue to collect fluid by gravity
collect air by water seal
keep the system hanging below the level of the chest throughout
