Chest Tubes

Question 1

Assist with insertion

Answer 1

Meds, prepare atrium, gather supplies, set up suction

Question 2

Chest tube indications

Answer 2

Pneumothorax, Hemothorax, Pleural Effusion

Question 3

Water Seal vs. Water Suction

Answer 3

Water seal: no suction to wall just drain
Water suction: Connected to wall suction at set negative pressure ex. -10, -20, -40

Question 4

Chest tube assessment

Answer 4

Respiratory Status: Rate and O2 saturation

Site and drainage: Bleeding and dressing

CT system and functioning: Check for air leak by taking off suction to see if bubbling occurs, check connection and tubing for leak.

Question 5

Signs and symptoms of pneumothorax/hemothorax

Answer 5

Pneumothorax/Hemothorax

Signs/symptoms: Restlessness, decrease BP, increased HR

Question 6

CT safety for traveling and while on unit

Answer 6

Secure atrium

Check to see if you need portable wall suction for transport

New CT placement verify placement on X-ray, attach to drainage system, and wall suction

Check orders for doctor on milking vs not milking/striping chest tube to keep patency

Check output every hour. If output exceeds 100ml/hr

Question 7

Process on removal of CT

Answer 7

Confirm order to remove CT.

If patient has pacer wires remove those first if cardiac tamponade occurs you will need CT.

View most recent chest XR to confirm no pneumothorax, pleural effusion or hemothorax

Once all of that is confirmed be sure you have all supplies: Vasoline gauze for pleural CT, gauze, tape, suture removal kit, quick clot if needed.

Tell patient to inhale and on exhalation remove in one quick and firm movement.

If a lot resistance occurs do not force CT removal.