Chest Tube

Difference between wet and dry

"Oasis" and E Dry

The nurse is preparing to assist the health care provider to remove a client's chest tube. Which instruction will the nurse correctly give to the client?

"When the tube is being removed, take a deep breath"

Be able to label and click on different chambers and what they do!

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List three types of pneumothorax and give example.

1. SPONTANEOUS - AIR ENTERS THE PLUERAL SPACE THROUGH A BREACH OF ONE OF THE PLEURA. 2. TRAMATIC - AIR ESCAPES FROM A LACERATION IN THE LUNG 3. TENSION - AIR IS DRAWN INTO THE PLURAL SPACE FROM A LACERATED LUNG OR WOUND IN THE CHEST

List three reasons a chest tube might be inserted into a patient:

1. TO RETURN NEGATIVE PRESSURE TO CHEST CAVITY 2. TO CLEAR EXCESSIVE AIR FROM THE INTRO PLUERAL SPACE 3. TO DRAIN BLOOD/FLUID FROM THE INTRA PLEURAL SPACE 4. TO RELIEVE RESPIRATORY DISTRESSS

Parts of the chest tube broken down by chambers A, B, C, D, E

A - suction B - water seal C - water leak (need 2cm water) D - Drainage chambers E - DRY only, bellow shows that suction is engaged

Continuous vigorous bubbling in chamber C

Air leak chamber Abnormal finding Means there is a leak in the system. If they have air.... then some bubbling is normal

Chamber A

Always the suction control In a dry system, don't need water added for suction Suction on the wall won't pull water out because of the one way valve

What to do if the drainage fills up

Can't empty it - have to do a new canister. Set everything up.

How would you know that suction is engaged for the chest tube

Chamber E - orange bellow

If the chest tube comes out and wound is exposed

Cover with Vaseline sterile gauze Call for x-ray stat Call Dr.

Atrium Oasis

DRY Has the valve on the top left one way valve allows air to leave the chest but prevents air from entering the chest sterile water in water seal chamber 2cm has bellow and dial suction chamber does not need water

When chest tube should be D/C

Dr has pt breath and cough - when there are no bubbles in chamber C Chest x-ray confirms

What is the reason for chest tubes after thoracic surgery?

Draining secretions, air, and blood from the thoracic cavity is necessary.

What if connection comes out but tube is still inserted

Emerge the tube completely in sterile water

To remove chest tube

Have pt take a deep breath, blow ALL air out (negative pressure), bare down like a bowel movement or hold breath. As soon as the tube is pulled out, cover with the Vaseline gauze.

Wet system

Likely will not see a wet system anymore Everything works the same except for the suction part. Get bottle of sterile water and add (depending on Dr's order) fill water until suction goes to the line of suction that the Dr ordered.

what if canister gets knocked over?

Messes with I & O Dr. may order a new canister Keep the canister on the floor BUT not under the bed

Consent for Chest Tube

Nurse job to get the consent signed. DOCTOR job to explain the procedure

In what type of pneumothorax does air enters the chest during inspiration and exits during expiration. A slight shift of the affected lung may occur because OF A DECREASE IN PRESSURE AS AIR MOVES OUT FO THE CHEST.

OPEN PNEUMOTHORAX

In general, chest drainage tubes are not indicated for a client undergoing which procedure?

Pneumonectomy

A nurse is educating a client in anticipation of a procedure that will require a water-sealed chest drainage system. What should the nurse tell the client and the family that this drainage system is used for?

Removing excess air and fluid

You are caring for a client status post lung resection. When assessing your client you find that the bubbling in the water-seal chamber for the chest tubes is more than you expected. What should you check when bubbling in the water-seal chamber is excessive?

See if there are leaks in the system

What fluid goes into the chest tube syste?

Sterile WATER NOT sterile saline *Read your labels

In what type of pneumothorax does air enter but can't leave the chest. If this is condition is untreated and the pressure continues and the great vessels are compressed and the mediastinal structures and trachea are shifted toward the opposite side.

TENSION PNEUMOTHORAX

Why would the water inside a chest tube system fluctuate?

The WATER level fluctuates with respiratory cycle. It INCREASES with inspiration and RETURNS TO BASELINE with expiration.

The parietal pleural lines the _____________ cavity, lateral wall of the mediastinum diaphragm and inner aspects of the ribs.

Thoracic cavity

The ______________ and _____________ surround the pleural cavity.

VISCERAL PLEURA PARIETAL PLEURA

What would indicate a possible chest tube system leak?

Vigorous bubbling in the water seal chamber.

Atrium Ocean

WET collection, water seal, and wet suction control chambers requires sterile water in water seal AND suction 2cm/20cm tidaling means it is functioning properly

After lobectomy for lung cancer, a client receives a chest tube connected to a disposable chest drainage system. The nurse observes that the drainage system is functioning correctly when she notes tidal movements or fluctuations in which compartment of the system as the client breathes?

Water-seal chamber

Titling

When it is going up and down with pt breathing shows that it is working Bubbling would show that there is air when the pt deep breaths and coughs

Chamber D (Drainage)

Will measure and mark with Sharpie (line, date, initials) document how much came out since previous shift marked.

How much drainage is too much drainage?

for open hear pt - 500mL For every 500mL dropped = 1 pt Hemoglobin drop

If chest tube catheter is pulled out

petroleum gauze and 4X4's, and tape around three sides

Chamber E

shows you the suction is engaged Orange bellow expands