chest tubes

Question 1

chest tubes

Answer 1

pleural or mediastinal
remove air/fluid from pleural space
restore negative intra-pleural pressure so that lungs can re-expand

Question 2

pleural space

Answer 2

potential space between visceral pleura and parietal pleura

Question 3

pleural fluid

Answer 3

50 mL
produced by pleural cells
separates and lubricates
holds 2 layers together creating negative pressure to keep lungs expanded

Question 4

when intrapleural pressure is equal to atmospheric pressure

Answer 4

lungs collapse

Question 5

pneumothorax

Answer 5

air in the cavity

rib fx, GSW, knife wound, thoracotomy, forceful coughing, bronchoscopy, spontaneous

Question 6

hemothorax

Answer 6

blood in pleural space

open chest procedures or blunt/penetrating trauma

Question 7

pleural effusion

Answer 7

excessive fluid accumulation in pleural space
HF, pneumonia, cancer, PE, post op
thoracentesis if large amts

Question 8

chylothorax

Answer 8

accumulation of lymphatic drainage

chest trauma, expanding tumor, chest surgery

Question 9

empyema

Answer 9

purulent pleural fluid
damages pleural membranes and must be removed
2/2 pneumonia

Question 10

cardiac tamponade

Answer 10

blood accumulation in mediastinal space

post op or chest trauma

Question 11

instillation of fluids in pleural space

Answer 11

chemotherapy
chemical pleurodesis
VATS procedure if recurring (adheres visceral and parietal pleura)

Question 12

chest tube placement (pneumothorax)

Answer 12

2-4th ICS

Question 13

chest tube placement (fluid)

Answer 13

8-9th ICS

Question 14

water seal

Answer 14

prevents air from returning to lung and acts as one-way valve

Question 15

suction

Answer 15

provides negative pressure to chest

aids in reinflating lung more quickly

Question 16

suction setting

Answer 16

-20cm

Question 17

patient presentation (air or fluid)

Answer 17

respiratory distress (tachycardia, tachypnea, hypoxia, restless, anxious)

Question 18

white on CXR

Answer 18

lung collapse

Question 19

documentation of chest tube insertion

Answer 19

chest tube size
insertion site
drainage
pt tolerance
meds before and during
results of CXR

Question 20

chest tube assessment

Answer 20

check for infection around site
change dressing daily
SpO2, lung sounds
assess for subcutaneous emphysema

Question 21

subcutaneous emphysema

Answer 21

air under tissue
crepitus
“bubble paper”

Question 22

tubing

Answer 22

prevent obstructions!
no dangling or dependent loops
no laying on tube

Question 23

to maintain drainage

Answer 23

gentle milking
no stripping/venting
report drainage > 200 mL/hr

Question 24

chest drainage unit (CDU)

Answer 24

never! elevate above chest (keep 12 inches below chest)
maintain 2cm water in water seal chamber
mark time of measurement and fluid level every 1-3 hrs
drainage > 100 mL per hour or at PCP direction call MD
red blood may indicate active bleeding

Question 25

tidaling

Answer 25

correspond w respirations rises on inspiration, falls on expiration reversed on vent pts no tidaling in water seal chamber!

Question 26

air leak indicator

Answer 26

bubbling indicates leak

Question 27

bubbling in water seal

Answer 27

intermittent bubbling is normal | continuous bubbling water seal -- CHANGE CDU

Question 28

if CDU is overturned

Answer 28

return to upright position avoid by taping CDU to floor or hanging off bed deep breaths followed by forced exhalation, cough

Question 29

if chest tube is pulled out

Answer 29

pinch skin together petroleum/occlusive dressing PCP

Question 30

if CDU breaks or has an air leak

Answer 30

place distal end of chest tube in 2 cm sterile water to recreate water seal

Question 31

clamps bedside

Answer 31

``` 2 rubber tipped hemostats when changing CDU/full assessment before removal of CT to assess pt tolerance assessment for air leaks never clamp with out PCP order ```

Question 32

improper clamping risk

Answer 32

tension pneumo | cardiac tamponade

Question 33

changing CDU

Answer 33

1. set up new unit 2. clamp 3. disconnect from "filled" CDU 4. reconnect to new CDU 5. remove clamp

Question 34

indications for removal

Answer 34

``` drainage has decreased (little to none) pt breathing normally w/o distress breath sounds at baseline no fluctuations in water-seal chamber CXR shows lung re-expansion with no residual air or fluid in the pleural space ```

Question 35

chest tube removal

Answer 35

``` medicate 30 min prior PCP removes sutures deep breath, removed on expiration dressing applied CXR monitor respiratory status, pain, infection ```

Question 36

short term chest tube

Answer 36

blake drain | pigtail catheter

Question 37

longer term chest tube

Answer 37

pleurex catheter

Question 38

home chest tubes

Answer 38

heimlich valve | pneumostat chest drain

Question 39

heimlich valve

Answer 39

for small uncomplicated pneumo no need for suction one way flutter valve to allow air to exit