Positioning & Chest Tubes

Question 1

Trendelenburg

Answer 1

Feet elevated higher than head

LEFT LATERAL: Suspected air embolism
= will cause air to rise to the RA.

NOT FOR:
- Most neuro conditions = increases ICP, pulls spinal fluid
- Ascites (risk for dyspnea)

Question 2

Lumbar puncture

Answer 2

Side-lying with the head, back, and knees flexed
= maintains spine in horizontal position

Question 3

Chest tube placement

Answer 3

Arm raised above head on the affected side w/ HOB at 30-45

Question 4

Femoral artery cardiac catheterization

Answer 4

Supine OR Reverse Trendelenburg
= reduces the risk for hemorrhage/pressure on artery

AVOID HIP FLEXION

Question 5

Post-liver biopsy

Answer 5

Right-lying for a min. of 2 hours, then supine for 12-14 hours
= applies pressure + splint the puncture site

Question 6

Semi-fowler

Answer 6

• Liver cirrhosis
• Ascites
  -Restraints
  -Post-op

*mostly to prevent aspiration and improve oxygenation

Question 7

Tripod position

Answer 7

To facilitate lung expansion

• Often seen in COPD/asthma exacerbation

Question 8

Orthopneic

Answer 8

Pt is sitting upright, leaning forward onto bedside table to support body weight
- Promote lung expansion

Question 9

Prone

Answer 9

Post-lower limb amputation
= prevents hip contracture

ARDS
= improve oxygenation

Question 10

Sims position

Answer 10

Enema administration

Laparoscopic abdominal procedure
=alleviate referred shoulder pain

Question 11

Purpose of Chest tubes

Answer 11

Re-establish negative pressure in the pleural space

Question 12

Pneumothorax

Answer 12

Puncture in lungs, allowing air to enter pleural space

Question 13

Hemothorax

Answer 13

Blood entering pleural space

Question 14

Apical vs Basilar Chest tube

Answer 14

The location of the chest tubes

APICAL
- Higher up in the chest
- Removes air
- Expect to bubble + no liquid drainage

BASILAR
- Bottom of the lungs
- Removes blood/liquids
- Expect to drain liquid + no bubbling

Question 15

How many + where is chest tube placement for:
- Unilateral pneumothorax
- Bilateral pneumothorax
- Post-op chest surgery

Answer 15

Unilateral pneumothorax
- 2; apical + basilar

Bilateral pneumothorax
- 2; one per side

Post-op chest surgery (assume unilateral)
- 2; apical + basilar

Question 16

T/F
Milk the chest tube to help with the drainage.

Answer 16

NEVER MILK THE TUBE

Question 17

What to do when the seal breaks?

First? Best?

Answer 17

1. CLAMP as close to pt as possible
   first - b/c only 15 secs w/o doc orders
2. CUT TUBING
3. Stick open end in STERILE WATER, then unclamp = water seal
   best

Question 18

What to do when chest tube is pulled out?

First? Best?

Answer 18

First - Glove hand and cover hole
Best - Cover hole with vaseline/adaptic gauze

Question 19

Bubbling chest tubes
- Water seal
- Suction control chamber

Answer 19

Water Seal
- Intermittent = GOOD
- Continuous = BAD, check for leak

Suction Control Chamber
- Intermittent = BAD, not enough suction
- Continuous = GOOD

Question 20

Thoracentesis vs Chest tube.

Answer 20

Thoracentesis is an “in-and-out chest tube”.

There is higher risk for infections in continuous chest tubes.