nursing practice for chest tube

Question 1

what is pleural effusion ?

Answer 1

Fluid between the pleural space

Question 2

what is pneumothorax ?

Answer 2

Air in the lungs

Question 3

what to do when patient has chest tube? (nursing)

Answer 3

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

Question 4

what are the different parts of a water seal suction called?

Answer 4

1. collection chamber
2. water seal chamber
3. air leak chamber
4. suction control chamber

Question 5

what to take note for collection chamber?

Answer 5

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

Question 6

what is the normal collection in chest tube with pleural effusion?

Answer 6

serous 20ml in 12 hour

Question 7

what is abnormal drainage ?

Answer 7

bloody, output greater than 100ml per hour

Question 8

what is considered normal in the water seal chamber?

Answer 8

1. fluctuation as the patient breathes (5-10cm)
2. 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 .

Question 9

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)

Answer 9

1. due to clot in chest tube
2. dependent loop or kink
3. chest drain not placed low enough
4. inline connectors not properly secured
5. dislodgement of catheter from patient
6. dislodgement of chest tube from connector

Question 10

what to do when there is dislodgement of catheter from the patient?

Answer 10

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

Question 11

what to do when there is dislodgement of chest tube from the connector ?

Answer 11

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

Question 12

problem 2 wsc:

What to do when there is constant bubbling in the water seal chamber?

Answer 12

it is probably due to air leak

Question 13

what to do when there is a airleak and continuous bubbling?

Answer 13

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

Question 14

what to do when there is an overfilled water seal chamber (water level above 3/4, 2cm) ?

Answer 14

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

Question 15

what to do when there is not enough water in the water seal chamber ?

Answer 15

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

Question 16

what are the normal sigs in the section control chamber ?

Answer 16

gentle bubbling

Question 17

what are the nursing check to take at the suction control chamber? how to check te pressure?

Answer 17

detach the chamber from the suction source and when bubbling stops check the water level

add until it reaches 20 or the ordered level

Question 18

what are the reasons for the suction control chamber not bubbling ?

Answer 18

there is possible disconnection of the suction source

Question 19

what is the reason behind vigorous bubbling in the suction chamber?

Answer 19

there is too much suction source pressure in the system

Question 20

what to do when there is vigorous bubbling in the suction chamber?

Answer 20

adjust the suction

Question 21

what to do when there is no bubbling in the suction chamber?

Answer 21

ensure that the suction tubing is connected and the suction source is turned on

Question 22

what to do when the chest drainage is being knocked over?

Answer 22

set the system upright and check the level of water in the water seal chamber and suction control chamber is correct and adjust accordingly

Question 23

what to do when the patient is transported or leaving the unit ?

Answer 23

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