Chest Tube Mx Flashcards
Patient Assessments r/t a Chest tube:
- Dressings (tight + intact) around chest tube
- Skin around chest tube
- puffiness, crackling/SQ emphysema, bleeding
- Signs of infection (erythema, purulent drainage)
- Assess for difficulty breathing (RR, lung sounds)
- Pulse ox to monitor breathing effectiveness
- Check alignment of trachea
- Check to see if tube “eyelets” are visible
- should NOT be visible
- Assess for pain
- Document drainage amount, color, & consistency
- obtain any drainage specimens from the actual tubing
Nursing Interventions r/t a Chest tube:
- Pain Mx
- Pulmonary hygiene (deep breaths, cough, IS)
- Reposition to side-lying if a report of “burning” pain in the chest (chest tube stuck to wall)
Positioning of the Chest tube Drainage system:
- Keep drainage system lower than pt’s chest
- Avoid kinks and dependent loops by keeping chest tube as straight as possible from bed to suction unit
- Keep the tubing above the drainage system so it doesn’t collect in the tubing
Do we connect the Chest tube to wall suction?
NOOOO!!!!
Use the Chest tube suction device
What should the suctioning of the chest tube drainage system unit be set to?
Turned up until there is gentle bubbling in the suction chamber (pg. 560)
Messer: 20 is the most common setting
When do we want to see bubbles in the water-seal chamber? (inspiration or expiration?)
Should see gentle bubbling on exhale
(May also see them during a forceful cough or position change)
What if we see continuous bubbling?
NOT OKAY → there’s an air leak somewhere
What if we see bubbling in the chest tube drainage system that looks like “burping (big bubbles)?”
Pneumothorax! (either worsened or new injury)
CALL RAPID RESPONSE!
Where should we assess for an air leak?
- Insertion site
- Tubing
- Tubing connectors
- Crack in the drainage collection
How to assess for an Air leak:
- Clamp the chest tube at the dressing with your fingers
- if bubbling stops → air leak at insertion site or lung itself
If bubbling continues:
2. Clamp the tubing just distal to the first tubing connector with your fingers
- if bubbling stops → air leak here → reinforce connector
If bubbling continues:
3. Clamp the tubing approx. every 12 inches or so to identify any leaks in the tubing
If you bubbling continues all the way down the tubing to the collection device:
4. Change the chest drainage system itself (not tubing?)
When assessing for an air leak, you must clamp the tubing with your fingers.
How long should you clamp for and why?
Clamp for only a few seconds!
Risk for a Tension Pneumothorax!!
What do you do if the pt’s chest tube dislodges from the patient?
- Apply a sterile occlusive dressing
- Close dressing on three sides
What do you do if the pt’s chest tube dislodges from anywhere other than the insertion site?
- Place the end of the tubing in 1-2 inches of sterile water to re-establish a water seal
What if we think the chest drain tubing is obstructed?
Use the hand-over-hand technique
DON’T “Milk” the tubing!! Risk for increased pressure
Mx of the Chest tube Drainage system:
- Ensure chest tube is securely taped to the connector and that connector is taped to the tubing going into the collection chamber.
- Assess for bubbling in the water-seal chamber.
- Assess for “tidaling” (rise and fall of water in 2nd chamber–indicates pressurized system is closed).
- Assess amount of water in the suction control chamber (set by provider) and in the water-seal chamber (set by manufacturer)
- Empty collection chamber or change system before drainage makes contact with bottom the tubing.
