Unit 4 Chapter 27 Chest Tube Flashcards
What is the function of the Chest Tube
reduce air in lungs or fluid(hemothorax) in lungs
REINFLATES THE LUNG
Posistioning of Chest tube for Tension pneumothorax
The tip of the tube used to drain air is placed near the front lung apex
^The wounds are covered with airtight dressings, most commonly silicone foam dressings
Positioning of Chest tube for Hemothorax
The tube that drains liquid is placed on the side near the base of the lung.
^The wounds are covered with airtight dressings, most commonly silicone foam dressings
Where should the drainage system be placed?
A. Placed above the chest
B.placed below the patient’s chest on a unmovable part of the bed.
C. On the side of the patient
D. above the head of the patient
B.placed below the patient’s chest on a unmovable part of the bed.
The chest tube is connected by about 6 feet of tubing to a collection device placed below the chest, allowing gravity to drain the pleural space while the patient can turn and move without pulling on the chest tube. When two chest tubes are inserted, they are joined by a Y-connector close to the patient and the 6 feet of tubing is a ttached to the Y-connector.
Managment of Chest Tube
- Ensure that the dressing on the chest around the tube is tight and intact. Depending on agency policy and the surgeon’s preference, reinforce or change loose dressings.
- Assess for difficulty breathing.
- Assess breathing effectiveness by pulse oximetry.
- Listen to breath sounds for each lung.
Check alignment of trachea.
Check tube insertion site for condition of the skin. Palpate area for puffiness or crackling that may indicate subcutaneous emphysema. - Observe site for signs of infection (redness, purulent drainage) or excessive bleeding.
Check to see if tube “eyelets” are visible (they should not be visible). - Assess for pain and its location and intensity and administer drugs for pain as prescribed.
Assist patient to deep breathe, cough, perform maximal sustained inhalations, and use incentive spirometry. - Reposition the patient who reports a “burning” pain in the chest.
Nursing Interventions for Drainage System
Do not “strip” the chest tube; use a hand-over-hand “milking” motion.
Keep drainage system lower than the level of the patient’s chest.
- Keep the chest tube as straight as possible from the bed to the suction unit, avoiding kinks and dependent loops. Extra tubing can be loosely coiled on the bed.
- Ensure that the chest tube is securely taped to the connector and that the connector is taped to the tubing going into the collection chamber.
- Assess bubbling in the water-seal chamber; should be gentle bubbling on patient’s exhalation, forceful cough, position changes.
Assess for “tidaling” (rise and fall of water in chamber two with breathing).
- Check water level in the water-seal chamber and keep at the level recommended by the manufacturer.
- Check water level in the suction control chamber and keep at the level prescribed by the surgeon (unless dry suction system is used).
- Clamp the chest tube only for brief periods to change the drainage system or when checking for air leaks.
- Check and document amount, color, and characteristics of fluid in the collection chamber as often as needed according to the patient’s condition and agency policy.
- Empty collection chamber or change the system before the drainage makes contact with the boom of the tube.
When a sample of drainage is needed for culture or other laboratory test, obtain it from the chest tube; after cleaning the chest tube, use a 20-gauge (or smaller) needle and draw up specimen into a syringe.
Immediately Notify Surgeon or Rapid Response Team CHEST TUBE
Immediately notify Surgeon or Rapid Response Team for:
- Tracheal deviation from midline
- Sudden onset or increased intensity of dyspnea
- Oxygen saturation less than 90%
- Drainage greater than 70 mL/hr
- Visible eyelets on chest tube
- Chest tube falls out or dislodges out of the patient’s chest (first, cover the area with dry, sterile gauze tape 3 sides
Chest tube disconnects from the drainage system (first, put end of tube in a container of sterile water and keep below the level of the patient’s chest)
- Drainage in tube stops (in the first 24 hours)*
What chamber should a nurse pay close attention to?
A. Water seal Chamber
B. Wet Chamber
C. Collection chamber
A. Water seal Chamber
You are providing care to a patient with a chest tube. On assessment of the drainage system, you note continuous bubbling in the water seal chamber and oscillation(harlem shake in water seal chamber). Which of the following is the CORRECT nursing intervention for this type of finding?*
A. Reposition the patient because the tubing is kinked.
B. Continue to monitor the drainage system.
C. Increase the suction to the drainage system until the bubbling stops.
D. Check the drainage system for an air leak
D. Check the drainage system for an air leak
- A patient is receiving positive pressure mechanical ventilation and has a chest tube. When assessing the water seal chamber what do you expect to find?
A. The water in the chamber will increase during inspiration and decrease during expiration.
B. There will be continuous bubbling noted in the chamber.
C. The water in the chamber will decrease during inspiration and increase during expiration.
D. The water in the chamber will not move.
C. The water in the chamber will decrease during inspiration and increase during expiration.
- The patient in room 2569 calls on the call light to tell you something is wrong with his chest tube. When you arrive to the room you note that the drainage system has fallen on its side and is leaking drainage onto the floor from a crack in the system. What is your next PRIORITY?
A. Place the patient in supine position and clamp the tubing.
B. Notify the physician immediately.
C. Disconnect the drainage system and get a new one.
D. Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system.
D. Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system.
- You’re assessing a patient who is post-opt from a chest tube insertion. On assessment, you note there is 50 cc of serosanguinous fluid in the drainage chamber, fluctuation of water in the water seal chamber when the patient breathes in and out, and bubbling in the suction control chamber. Which of the following is the most appropriate nursing intervention?
A. Document your findings as normal.
B. Assess for an air leak due to bubbling noted in the suction chamber.
C. Notify the physician about the drainage.
D. Milk the tubing to ensure patency of the tubes.
A. Document your findings as normal.
- A patient is recovering from a pneumothorax and has a chest tube present. Which of the following is an appropriate finding when assessing the chest tube drainage system?
A. Intermittent bubbling may be noted in the water seal chamber.
B. 200 cc of drainage per hour is expected during recovery of a pneumothorax.
C. The chest tube is positioned at the patient’s chest level to facilitate drainage.
D. All of these options are appropriate findings.
A. Intermittent bubbling may be noted in the water seal chamber.
- While helping a patient with a chest tube reposition in the bed, the chest tube becomes dislodged. What is your immediate nursing intervention?
A. Stay with the patient and monitor their vital signs while another nurse notifies the physician.
B. Place a sterile dressing over the site and tape it on three sides and notify the physician.
C. Attempt to re-insert the tube.
D. Keep the site open to air and notify the physician.
B. Place a sterile dressing over the site and tape it on three sides and notify the physician.
- A patient with a chest tube has no fluctuation of water in the water seal chamber. What could be the cause of this?
A. This is an expected finding.
B. The lung may have re-expanded or there is a kink in the system.
C. The system is broken and needs to be replaced.
D. There is an air leak in the tubing.
B. The lung may have re-expanded or there is a kink in the system.
Absence of tidaling may mean that the lung has fully re-expanded or that there is an obstruction in the chest tube.
assess for obstruction, if none if present notify provider that there may be lung reexpansion present
