Chest tubes

Question 1

What does the pleural cavity cover?

Answer 1

The lungs

Question 2

What does the Mediastinal cavity cover?

Answer 2

The heart

Question 3

What should be in the pleural cavity?

Answer 3

Nothing except 5-10mL of lubricating fluid for inhale & exhale ease

Question 4

What is the thorax natural state?

Answer 4

Expansion

Question 5

What is the lung natural state?

Answer 5

Collapse

Question 6

The thorax and lungs exist has _____ forces and state of ___ intrapleural pressure?

Answer 6

opposing
Negative

Question 7

What happens if the negative pressure is lost in the pleura space?

Answer 7

the 2 pleura separate (lung collapses)

Question 8

Who requires chest drainage?

Answer 8

-Heart failure
-Thoracic surgery
-Central line accidentally gets in intrapleural space
-Spontaneous bleb rupture
-Malignacies
-Decrease in colloidal osmotic pressure

Question 9

Pneumothorax

Answer 9

Air in pleural space

Question 10

Spontaneous pneumothorax

Answer 10

no apparent cause

Question 11

Hemothorax

Answer 11

Blood in pleural space

Question 12

Thoracotomy

Answer 12

Surgical opening into thorax

Question 13

Thoracentesis

Answer 13

Removal of pleural fluid with large bore needle (Provider done)

Question 14

Pleural effusion

Answer 14

excess fluid in pleural space (CXR if >300mLs)
-Impairs oxygenation, decreases surface area, SOB

Question 15

Empysema

Answer 15

Pus in pleural space

Question 16

What would you hear if somebody had a pleural effusion?

Answer 16

No or decreased breath sounds

Question 17

If somebody has open heart surgery what would be in their pleural space?

Answer 17

Blood and air

Question 18

If somebody has a bleb and spontaneous lung collapse what would be in their pleural space?

Answer 18

air

Question 19

What is the next best nursing action if <20% pneumothorax?

Answer 19

bedrest, limited activity, let it reabsorb on its own

Question 20

What is the next best nursing action if >20% pneumothorax?

Answer 20

contact HCP for thoracentesis or insertion of chest tube attached to an underwater seal

Question 21

What is the nursing action with chest tube insertion?

Answer 21

-Stay w/ patient (painful)
-Premedicate
-Obtain thoracotomy tray, chest tube, & drainage system
-Help maintain correct position

Question 21

Where would a chest tube be placed if draining air?

Answer 21

Apex of lung

Question 22

Where would a chest tube be placed if draining blood?

Answer 22

Base of lung

Question 23

What are the 3 compartment of the atrium?

Answer 23

1. Suction chamber
2. Water seal chamber
3. Drainage chamber

Question 24

When is increased CT drainage expected?

Answer 24

During ambulation

Question 25

What does the collection chamber do?

Answer 25

Accepts air or fluid from the system through extension tubing directly attached to the patients chest tube

Question 26

What does the water seal chamber do?

Answer 26

Acts as a one way valve to prevent airflow back into the patient -Filled with sterile water to 2 cm mark (allow air to leave pleural space but not reenter)

Question 27

What does the suction chamber do?

Answer 27

-Regulates amount of negative suction being exerted on intrapleural space -Ensure dial is turned -Has visual alert to indicate correct suction (orange)

Question 28

Increasing the vacuum suction source will _____ pressure

Answer 28

NOT increase

Question 29

The extension tubing is either attached to ____ or ________. It should never be _________

Answer 29

Wall suction or Open to air (under water suction) occluded

Question 30

What is the danger of clamping/occluding the air vent?

Answer 30

Tension pneumothorax

Question 31

How much suction is chest tubes typically at?

Answer 31

20cm

Question 32

When the provider is ready to 'wean the patient' from the chest tube, the nurse will receive an order to "change CT from sx to UWS" so the nurse would

Answer 32

Turn off suction Take tubing off Leave open to air

Question 33

Assessment of pt with chest tube in place?

Answer 33

-VS -Resp assessment: O2 stat, ABG, resp effort, lung auscultation, skin/mucous membrane color, cap refill, CXR findings -Get OOB -Aggressive Pulm toilet

Question 34

Management of pt with chest tube in place?

Answer 34

-HOB raised -Collection chamber below level of chest -ATC pain meds -Teach about pul toilet/ Splinting -ROM exercises w/ affected should

Question 35

How should you assess insertion site?

Answer 35

-Occlusive, dry, intact -Bleeding: mark edge of are and notify HCP -Palpate for subcutaneous emphysema (aka crepitus) which is atmospheric air in subQ space, notify HCP

Question 36

How should you assess the extension tubing?

Answer 36

Ensure connections intact & avoid excessive dependent looping

Question 37

How should you assess the collection chamber?

Answer 37

-Check blood/fluid output -Not volume and appearance -Chart I&O and mark -Expected increase ambulation -Expected decrease sleeping

Question 38

How should you assess the water seal chamber?

Answer 38

-ensure water level at 2cm w/ sterile water -Assess for fluctuations or tidaling if under water suction -Assess for abnormal bubbling (intermittent is okay continuous is not)

Question 39

Is it expected to see tidaling in the water chamber when the pt coughs?

Answer 39

Yes

Question 40

What does no tidaling mean?

Answer 40

1. lungs have re-expanded or time to take out 2. kink/ obstruction 3. suction is on

Question 41

What does continuous bubbling mean?

Answer 41

potential leak in system

Question 42

If continuous bubbling noted in the water seal, what should you do?

Answer 42

Gently apple a padded clamp on drainage tubing close to occlusive dressing momentarily

Question 43

If bubbling stops with clamp-->

Answer 43

indicates leak at exit site or inside pt

Question 44

If bubbling continues with clamp-->

Answer 44

indicate air leak is between clamp and drainage system (check connections or replace system-nurse can do it)

Question 45

When is it appropriate to clamp a chest tube?

Answer 45

1. Determine air leak location 2. To replace drainage system 3. If provider orders it (see if pt tolerates it before removal) NO clamping during transport or if accidentally disconnected

Question 46

What is a pneumostat?

Answer 46

For the pt who sis ready to go home but chest tube not quite ready to come out (like pneumothorax)

Question 47

What is a PleurX catheter system used for?

Answer 47

-Recurrent pleural effusions (HF or malignancies) -Malignant ascites (fluid in peritoneum)

Question 48

When does a patient drain fluid with a pleurX catheter system?

Answer 48

Drains at home when symptomatic

Question 49

Benefits of PleurX?

Answer 49

-Less hospital trips & decreased length of stay -pt has control -decreased resp complications -safe and easy

Question 50

Which pt gets CT to suction vs UWS?

Answer 50

Provider decision Usually start on suction than UWS

Question 51

The provider orders the pt with a CT to walk in hall TID. Can that be done?

Answer 51

Yes, x2 nurses. If connected to suction disconnect adn leave air vent to open and keep drainage container low

Question 52

What do i do if CT inadvertently pulled out of the chest?

Answer 52

Vaseline gauze (occlusive) placed on exit site to prevent atmospheric pressure from entering pleural space

Question 53

What to do if the tubing accident ally becomes disconnected?

Answer 53

Take tube that is disconnected and stick it in bottle of sterile saline and create immediate UWS that way

Question 54

Chest tube removal-

Answer 54

-Done by provider -Cut sutures -Apply sterile petroleum gauze dsg -Have pt to take deep breath & bear down -Remove tube -Airtight dressing applied -Mark drainage