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Flashcards in Chest and drainage tubes Deck (17)
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1

purpose of chest tube

used to
reestablish intrapleural pressure,
re-expand the lung
improve oxygenation

2

What do CT drain

-hemothorax: blood
-pneumothorax:air
-pleural effusion: fluid
-empyema: pus

3

process of inspiration and expiration

The lungs are suspended in the thoracic cavity which is normally at a slight negative pressure. When the diaphragm is lowered, that pressure becomes more negative and the lungs expand into the cavity. Air from the atmosphere moves into the resulting partial vacuum and inflates the alveoli.

4

chest tube placement

-consent
-placement
-sutured in place
-airtight dressings/vasoline gauze
-attached to closed drainage system (may or may not be used with suction)
-CXR to confirm placement

5

disposable 3 chamber system

-drainage collecting
-water seal chamber
-suction chamber

6

to do assess for when patient has a 3 chamber system

-feel around the site of insertion for crepitus (air in the skin)

7

what should be at bedside if the chest tube disconnects?

keep a bottle fo sterile saline at the bedside. If chest tube disconnects from drainage unit, submerge the end in water. This is done instead of clamping to prevent tension pneumothorax

8

chest drainage system: collection chamber

-purpose?, documentation? what to report?

-acts as reservoir for fluid and air draining from chest tube.
-keep upright
-mark level q1 for 24hrs then q8 hours: do not empty
-report excessive drainage greater than 100mL/hour
-note consistency of drainage, purulent, vs bright red

9

chest drainage system: water seal chamber

-has one way valve/ water seal that prevent air form moving back into the chest with inspiration.
-fill to 2 cm of H2O
-tidals with respiration: cessation of tidaling
-continuous bubbling indicates air leak: assess system
-air leak monitor: indicates degree of air leak if present

10

tidal and tidaling

increase in water level with inspiration and return to the baseline (2cm) during exaltation.

11

what does cessation of tidaling mean?

can mean that lung has re-expanded or and obstruction in the system

12

chest drainage system: suction chamber

Why is suction applied? what does suction control chamber do? how do you know if it is working properly? what to set suction to?

-suction may be applied to create negative pressure and promote drainage of fluid and removal of air
-suction control chamber: regulates the amount go negative pressure applied to the chest. amount of suction determined by water level (20cm)
-when suction is on: bubbling appears in the suction chamber
-dry: set to -20cm using dial
-wet: degree of suction is set by water level (20cm H2O)

13

care considerations with chest tube

-semi fowlers position
-coughing and deep breathing q2: use incentive spirometer
assess:
- subcutaneous emphysema
-respiratory status
-drainage
-occlusive dressing
-all connections taped
-tubing free of kinks
-site for s/s infection

14

subcutaneous emphysema

-has a characterizes crackling feel to the touch
feeling is called subcutaneous crepitation

15

risk fir tension pneumothorax

-symptoms? what not to do?

-never clamp tubing unless necessary
-do not strip or milk tubing
symptoms:
- tracheal deviation
-absent breath sounds on 1 side
-JVD
-respiratory distress
-asymmetrical lung expansion
-cyanosis

16

general survey of CT

-collection device upright, and below level of tube insertion
-ER equipment: 2 kelly clamps, 1 vaseline gauze, 4x4 gauze, new drainage system, sterile water of settle saline
-check: water seal chamber tidaling, suction chamber bubbling, suction set at right level

17

Chest tube removal

-indications
-assist the physcian
-pre and post assessment: breath sounds, RR, oxygen saturation, pain
-premedication 15-30minutes before
-site secured with occlusive dressing and heavy weight stretch tape
-expect a CXR to be ordered