Thoracic Chest Procedures Flashcards
Why are Thoracentesis Performed ?
To remove fluid or air from the pleural space
Throacentesis provide what ?
Analysis of lung fluids to determine cause of the effusion
Thoracentesis fluid may be sent for what ?
for culture or cancer cells
What should be done pre-procedure for Thoracentesis ?
- Check for signed informed consent (invasive procedure)
- Stop any anticoagulant medications
- Obtain baseline vital signs, O2 saturation & pain level
- Be sure that a chest x-ray has been performed
- Position client sitting on side of bed, feet supported, & leaning over bedside table
(if pt. can’t sit up, lie on unaffected side w/HOB @ 45º)
How should you position a client receiving a Thoracentesis ?
Sitting on edge of bed
feet supported
leaning over the bedside table
How should you position a client receiving a Thoracentesis, who can’t sit up ?
Lie on unaffected side With HOB at 45º
Where is the fluid, blood, or exudate being removed from in a Thoracentesis ?
Pleural space
During a Thoracentesis procedure, the client must be ?
Very still; no coughing or deep breaths
As the fluid is removed in a Thoracentesis, what should happen to the lung ?
It should re-expand
What should the nurse be assessing during a Thoracentesis procedure ?
Vital signs, oxygen sats and pain level
Compare to baseline
If a large amount of fluid is removed in a Thoracentesis, what should you watch for ?
Hypovolemia & shock
What should be done again post-Thoracentesis procedure ?
Another chest x-ray
What should the nurse check for post-Thoracentesis procedure ?
Check puncture site and dressing for bleeding
What other things should be done post-Thoracentesis procedure ?
- Monitor vital signs
- Listen to lungs for absent or reduced breath sounds on the affected side
- Monitor for subcutaneous emphysema, infection, and tension pneumothorax
What should you have a client do post-thoracentesis procedure ?
Turn, cough, and deep breathe
What has happened in a client who requires a chest tube ?
The lung has collapsed
If the chest tube is placed in the upper anterior chest (2nd intercostal space), what is it removing ?
Air
If the chest tube is placed laterally in the lower chest (8th or 9th intercostal space), then it is for ?
Drainage
_________ rises, and ________ settles ?
Air rises
Drainage settles
Can a client have both air & drainage in the lung ?
Yes!
What happens if a client has both air & drainage in the lung ?
They are Y-connected together and attached to a closed chest drainage unit (CDU)
How are chest tubes secured ?
It is sutured to the chest wall & with an airtight dressing applied around the chest tube exit site
- the chest tube is then connected to a closed chest drainage unit
- What is the purpose of the CDU ?
The purpose to restore the normal vacuum pressure in the pleural space.
(the CDU does this by removing all air and fluid in a closed one-way system until the problem is corrected)
What are the 3 chambers of the CDU ?
- ) Drainage collection chamber
- ) Water seal chamber
- ) Suction Control chamber
Drainage Collection Chamber ?
The chest tube connects to a 6 foot (flexibility to move) connection tube that leads to the drainage collection chamber
What do you do if the Drainage Collection Chamber fills up ?
Get another
one chamber holds 2,000mL
What can happen if a Drainage Collection Chamber over fills ?
If it over fills, it can cause tension pneumothorax & spill into the water chamber
What is the purpose of a water seal chamber ?
To promote one-way flow out of the pleural space which will prevent air from moving back up the system and into the pleural space
The Drainage chamber and the Water seal chamber are connected by what ?
Connected by a small tube that allows the drainage to remain in the first chamber and the air to go down into the water of the water seal chamber
The Water seal chamber contain what ?
Contains 2cm of water which acts as a one-way valve.
In other words, we are preventing backflow
In a Water Seal Chamber, you may see bubbling when ?
When the client coughs, sneezes, or exhales. (normal)
______________ bubbling is okay when the client coughs, sneezes, or exhales ?
Intermittent
You will see a sight rise and fall of water in the water seal tube when what ?
As the client breathes
What happens if titling stops in the water seal chamber ?
It usually means that the lung has re-expanded
What type of control chamber will be used if the client needs suction to remove air or fluid ?
Suction Control Chamber
