Chest Tubes

Question 1

What is the purpose of chest tubes?

Answer 1

To re-establish pressure in the pleural space *PAY ATTENTION TO WHY THE CHEST TUBE WAS PUT IN THE PATIENT! chest tube REMOVES

AIR pneumothorax
BLOOD hemothorax
AIR AND BLOOD pneumohemothorax

Question 2

Location of chest tubes

Answer 2

Apical (top) removes air (A)
Basilar (bottom) removes blood (B)

Question 3

How many chest tubes (and where) for unilateral pneumothorax?

Answer 3

one apical

Question 4

How many chest tubes (and where) for bilateral pneumothorax?

Answer 4

two apical

Question 5

How many chest tubes (and where) for post-op chest surgery?

Answer 5

always assume unilateral pneumohemothorax (2 tubes apical and basilar same side)

Question 6

What do you do if the water seal on a chest tube breaks?

Answer 6

FIRST - clamp, cut tube away from broken device, submerge under water, unclamp
BEST - SUBMERGE! need to recreate water seal

Question 7

What do you do if a chest tube comes out?

Answer 7

FIRST - cover with hand, put on vaseline (sticky) gauze dressing, dry sterile dressing, then tape 3 sides leaving bottom open for air flow

BEST - vaseline dressing to cover and seal

Question 8

Chest tube bubbling - ask yourself 2 questions

Answer 8

Where is it bubbling/ water seal or suction control chamber

When is it bubbling?
Water seal intermittently = good, working
Water seal continuously = BAD! leaking

Suction control chamber intermittently = bad. need to increase suction
Suction control chamber continuously = good

Question 9

Rules for clamping the chest tube

Answer 9

NEVER in routine care, ONLY in emergency when water seal breaks, never >15 scds and need dr order