UWSD

Question 1

What is the purpose of a chest tube ?

Answer 1

A tube inserted into the pleural space to remove air/fluid and help lung re-expand
OR
Tube inserted in mediastinum space to drain fluid from around the heart after cardiac surgery

Question 2

What are the reasons for a chest tube ?

Answer 2

-pneumothorax (air enters pleural space)
-pleural effusion (fluid in pleural space)
- haemothorax (blood enters pleural space)
-empyema (infection in pleural space)
-chylothorax(lymphatic fluid in pleural space)
- cardiac surgery

Question 3

What are the different types of chest tube drainage ?

Answer 3

• wet suction
• dry suction

Question 4

What is the nurses role w chest tubes

Answer 4

• keep drainage sys below pts chest
  -keep tubing free from kinks + that it drains freely + connections are sealed
  -monitor drainage collection chamber : drainage colour + amount + record reg
  -monitor water seal drainage 2 see if water lvl fluctuating
  -H2O in water chamber can evaporate so make sure to refill reg @ prescribed amount 4 suction
  -monitor air leak monitor 4 excessive bubbling (not good)
  -check suction pressure

Question 5

How does the water seal chamber work ?

Answer 5

Performs underwater seal to allow air to be removed from pleural space while preventing outside air from entering lungs (creates neg pressure)
- water will fluctuate as pt breathes in and out
- water will increase during inspiration +decrease during expiration (opposite if pt on positive pressure device )

Question 6

What does it mean if the water in the water seal chamber is not fluctuating at all?

Answer 6

• lung may have re-expanded (prob corrected
• there is a kink somewhere

Question 7

What are we looking for in the air leak monitoring area ?

Answer 7

• excessive bubbling as it could mean air leak
• if pt has pneumothorax there could be intermittent bubbling

Question 8

What is the assessment nd mgt 4 pts w a chest tube ?

Answer 8

Monitor pts :
-lung sounds
-resp rate nd effort
-4 dysopnea
-SpO2 readings
- insertion site - free 4rm infection
- sub-cut crepitus ( CO2 escaping into tissues - will feel puffy + like crackling sensation under d skin)
Encourage pt 2 cough + deep breathing - moves fluid and helps lung function
Reposition pt reg
Check drainage tubing
Check CDU (collection chamber, water seal chamber, suction Chamber)

Question 9

What should you do if a pts chest tube becomes dislodged?

Answer 9

-cover site w sterile dress + tape on 3 sides + notify doc

Question 10

What should you do if the system breaks ?

Answer 10

Insert tubing 1-inch into bottle of sterile water + get new drainage system

Question 11

What is the protocol for clamping the tube ?

Answer 11

Follow hospital policy as clamping ^ risk of tension pneumothorax
Never clamp w/o doctors order

Question 12

What are the functions of a chest tube

Answer 12

-drain fluid and/or air from chest
-prevent air from entering chest and creating a pneumothorax
-control the lvl of suction (if being used ) to facilitate re-expansion of the lung

Question 13

What are the chambers that chest drainage units consist of ?

Answer 13

1. Chamber that collects the chest drainage
2. Chamber that prevents air from entering the chest
3. Chamber that controls suction

Question 14

What are the times where the suction chamber is used ?

Answer 14

• to assist removal of thick drainage,bloody drainage or large amounts of drainage

Question 15

What is the difference between a wet suction unit and dry suction unit ?

Answer 15

Wet suction- uses chamber filled w water to control lvl of suction
Dry suction- uses mechanical suction control rather than a water sealed chamber (more popular choice)

Question 16

What should be done 2 the suction when not in use ?

Answer 16

Leave suction port open