Chest tubes

Question 1

what interrupts the negative pressure system of the lungs?

Answer 1

Trauma, disease, surgery

pneumothorax- air
hemothorax- blood

may leak into the pleural cavity

a closed drainage system and chest tube inserted to promote drainage so lung can reexpand.

thoracostomy tube/thoracic catheter

Question 2

placement

Answer 2

higher for air and lower for blood/fluid

mediastinal to drain around heart

Question 3

what is used?

Answer 3

water seal chambers
> fluid drains into the 1st chamber, 2nd chamber contains the water seal which allows air to escape bc of force of expiration but not reenter.

> waterless ones have one-way valves at top of system

> the suction control chamber contains suction controlled float ball that is set by a suction control dial after the suction is connected and turned on.

Question 4

Assess:

Answer 4

vitals, breathing, Hgb/Hct, resps =, pain

Question 5

set up water seal

Answer 5

1. IDy pt two identifiers
2. remain sterile of drain tubingm put sterile water in water seal chamber.
3. if it is the suction system. turn onto the prescribed suction. Suction control vent must NOT be occluded!!!**
4. tape all tubing connections in double spiral
   > clamp drainage tubing until ready to turn on.
5. unclamp tube and turn on suction.
6. assess vitals q 15 min for first 2 hrs, if directly after insertion. and monitor drainage too.
   > mediastinal tube- no more than 500mls in 24 hrs
   > posterior tube- 500-1000 in 24 hrs
   >anterior chest tube (pneumothorax)- little to no output
7. observe dressing
8. palp for SC emphysema (crackling)
9. check for leaks

Question 6

chylothorax

Answer 6

pus pneumonia

Question 7

pleurodesis

Answer 7

or recurrent malignant effusions

Question 8

tension pneumothorax

Answer 8

causes mediastinal shifts pushing the heart, great vessels and lungs

S&S: severe resp distress, low O2 sat, chest pain, absence breath sounds, tracheal shift, hypotension and sign of shock, tachycardia

Question 9

treatment for pleural conditions

Answer 9

1. remove fluid and air asap
2. prevent drained air and fluid from returning to the pleural space to re-expand the lung
3. restore - pressure in pleural space to reexpand lung.

Question 10

how does it work?

Answer 10

expiratory + pressure from the PT helps push air and fluid out of the chest (cough)

> gravity helps

> suction can help

Question 11

Pleur-evac

Answer 11

• disposable
• needless
• can be connected to suction or left open to gravity

Consists of:

1. collection chamber
2. water seal chamber
3. suction control chamber

Question 12

suction control chamber

Answer 12

• upper left side
  > -10, -15, -20, -30, -40 cm of h2o
  > when attached to suction, increase the amount of wall suction in the window (usually about 80-100)
  **note the setting on the unit actually determines the approp amout of suction.

Question 13

water seal chamber

purpose

prep

Answer 13

Purp- to allow air to exit from pleural space on exhale

prep- pore water in up to 2cm water level
STERILE WATER***

bubble will intermit if cough or a little on exhale if pneumo.

> the air leak meter- indicates degree of leak
shows bubbles in columns
low1 to high 7

Question 14

+ pressure valve

Answer 14

opens with increase + pressure, preventing pressure accumulation

Question 15

high - float pressure

Answer 15

preserves water seal in the presence of high negativity. used to reduce -

> water floats the valve up into the closed position when excessive - occurs

Caution!! if suction is not operative while depressing this valve, - pressure may be reduced to zero (atmosphere) and could result in pneumothorax

Question 16

collection chamber

Answer 16

to collect drainage up to 2500cc

Question 17

clamp or not?

Answer 17

VERY BIG DEAL
only if:
> changing vac
> assessing the system for leak
> after pleurodesis for malignant effusions/sclerosis
> prior to the removal of the tube

Question 18

N, prior to insertion

Answer 18

> informed consent
> complete baseline VS
>complete rest assess
> gather equip
>>thoracotomy tray
>> chest tube
>>dressing material (mepore, drain sponge)
>> Pleur-evac

tube size 16-24 fr

Question 19

N, post insertion

Answer 19

> prep for x-ray
> VS
> resp asses
> palp around site SC emphasema
> note drainage
> bubbles?
> have two clamps near by
> 250-500ml bottle of sterile water and 2 alcohol swabs at bedside incase tube disconnects

Question 20

ongoing PT assess

Answer 20

at start or shift and q 4 hr

> resp
> VS
> pain
> treacha position
> dressing D&I
> SC emph
>system kinks, float

Question 21

trouble shoot

Answer 21

air leak present- cover with gauze and tape on 3 sides
> occasionally on exhale, gently lift open side to allow air to exit intra-pleural space

no air leak- cover site with occlusive dressing and secure

if tube comes out! put end in bottle of sterile water and call doc

if system tips over, integrity is compromised = replace unit

document

Question 22

when is it time to come out?

Answer 22

> no air leaks evident the day bfr considering removal
drain less than 50cc/8hr or 100cc/day
pt able to tolerate chest tube drainage system being brought to water seal from suction
chest x-ray shows complete re-expansion of the lung