Respiratory Diagnostic Procedures

Question 1

Allen’s Test
- Purpose
- How to do

Answer 1

• Shows radial artery can be used to get ABG; Assess arterial blood flow
• Compress ulnar & radial arteries simultaneously while asking pt to form fist.
• Relax hand and assess palm & finger blanching, then let go of pressure.
• Hand should turn pink within 15 secs.

Question 2

Bronchoscopy
- purpose

Answer 2

• visualization of larynx, trachea, and bronchi
• biopsy of tissue
• aspiration of deep sputum or lung abscesses

Question 3

considerations for bronchoscopy

Answer 3

• remove dentures
• maintain NPO 4-8hrs prior

Question 4

Thoracentesis
- purpose

Answer 4

• surgical perforation of chest wall and pleural space with large bore needle
• local anesthesia w/ ultrasound
• get specimens, instill meds, or remove air or fluids

Question 5

what are the 3 chambers of chest tube drainage system

Answer 5

• drainage
• water seal
• suction control (wet or dry)

Question 6

what conditions would you use thoracentesis

Answer 6

• transudates (HF, cirrhosis, hypoproteinemia)
• exudates (inflammation, infection)
• empyema (collection of pus)
• pneumonia
• chest injuries/sx

Question 7

complications that can occur with thoracentesis

Answer 7

• mediastinal shift
• pneumothorax
• bleeding
• infection

Question 8

what position should the pt be prior to a thoracentesis procedure

Answer 8

upright and bend over the bedside table

Question 9

Things to do to make sure chest tube drainage system is working properly

Answer 9

• keep chamber upright and below insertion site
• add water as needed
• suction: water determines suction given: most likely -20 cm is given
• water will rise with inspiration and fall with expiration (tidaling)
• bubbling is NOT good in water seal chamber: air leak; gentle bubbling in suction chamber EXPECTED

Question 10

what conditions is chest tube insertion for

Answer 10

• pneumothorax
• hemothorax
• post-op drainage
• pleural effusion
• pulmonary emphysema

Question 11

how often to check chest tube drainage
when to report to provider

Answer 11

• hourly for first 24hrs
  then q8hrs
• check for cloudy or red drainage to report to provider
• report excessive drainage of 70mL/hr
• monitor insertion site for redness, crepitus, infection

Question 12

how to avoid pt getting tension pneumothorax from chest tube insertion

Answer 12

• high suction, prolonged clamping, kink/obstruction of tubing, mechanical ventilation with high positive end expiratory pressure (PEEP)

Question 13

how to safely remove chest tube

Answer 13

• give pt pain meds 30mins prior
• provide sutures to provider
• teach pt to do the Valsalva maneuver and hold during removal
• apply airtight sterile petroleum jelly gauze dressing, secure with tape
• CXR

Question 14

what to always keep by the pt’s bedside that has chest tube insertion

Answer 14

• 2 enclosed hemostats
• sterile water
• occlusive dressing