Closed chest - Chest tubes. Lewis pgs 519-524

Your patient is back in bed in high-Fowler's position. Which of the following should you do next? A. Prepare for another chest-tube insertion. B. Assess the rate, depth, and quality of the patient's respirations.

B. Assess the rate, depth, and quality of the patient's respirations. Determine the extent of respiratory distress from chest-tube removal and the patient's need for supplemental oxygen. Expect to find the affected lung field dull to percussion due to the presence of blood and to find decreased breath sounds as well. Finally, prepare for another chest-tube insertion.

You secure an occlusive dressing over the chest-tube insertion site to prevent worsening the hemothorax with additional air entry. Which of the following should you do next? A. Prepare for another chest-tube insertion. B. Assist the patient back into bed in high-Fowler's position. C. Assess the rate, depth, and quality of the patient's respirations.

B. Assist the patient back into bed in high-Fowler's position. Your patient's safety is your highest priority. Help the patient to sit back in bed to prevent injury due to a fall or instability. High-Fowler's position promotes drainage of fluid.

You continue to assess your patient's respiration and find her breath sounds on the left side improved but not yet optimal. Which action should you take next? A. Arrange for a portable chest x-ray. B. Check the connections and functioning of the closed-chest drainage system.

B. Check the connections and functioning of the closed-chest drainage system. You monitor the security of the connections between the chest tube and closed-chest drainage system and make sure the tubing is free of any kinks, dependent loops, or occlusion. Any of these might cause a rapid decline in the patient's respiratory status. You also observe the water seal chamber for tidaling, and check the suction control chamber to confirm the presence of gentle bubbling.

The patient follows your instructions to exhale fully and cough. Which action should you take next? A. Reconnect the chest tube to the collection chamber port. B. Clamp the chest tube near the insertion site. C. Disinfect the end of the chest tube.

B. Clamp the chest tube near the insertion site. You may clamp the chest tube just for a moment as long as you see no signs of an air leak, such as continuous bubbling in the water-seal chamber. If there is an air leak, immerse the end of the chest tube in 1 inch of sterile fluid to re-establish the water seal.

You see no signs of an air leak. Which action should you take next? A. Reconnect the chest tube to the collection chamber port. B. Disinfect the end of the chest tube.

B. Disinfect the end of the chest tube. If the fluid from the collection chamber has contaminated the other chambers, you should replace the drainage system. If not, proceed to disinfect the end of the chest tube to remove pathogens or debris.

You verify that the chest tube is secure. Which of the following should you do next? A. Coil the tube so it does not drag behind the patient. B. Have the patient log roll onto his unaffected side. C. Ask the patient to swing his legs around while you move the tube.

B. Have the patient log roll onto his unaffected side. This is to prevent manipulation or occlusion of the chest tube.

What should I do if the patients chest tude detaches from the drainage system?

Quickly submerge the end of the chest tube in 1 inch of sterile water. This helps maintain the seal while preparing the system for reattachment or replacement. That includes cutting off or disinfecting any potentially contaminated tubing ends.

Signs and Symptoms of Pneumothorax, tension pneumothorax or Hemothorax. What signs/manifestations indicates that a patient may need a chest tube?

Uneven chest expansion Tachycardia Tacypnea Shortness of breathe Pain on inspiration Shallow breathes Hypotension Distended neck veins Respiratory assessment

How often should the disposable closed chest drainage system be replaced?

Unless the system has been compromised in some way, there is no need to replace it until the collection chamber is nearly full.

What are the nursing interventions if the drainage system has tipped over or is disrupted or damaged, or the drainage collection chamber is filled to its maximum capacity?

Replace it.

What to think about when preparing the patient for chest tube insertion.

Get signed consent form (Nurse is responsible for this). Gather equipment. Includes; Thoracotomy or chest tube tray, Chest drainage unit or Heimlich valve, Chest tube, Sterile water, Lidocaine, Suction tubing and collection chamber, Occlusive dressing - at the bedside at all times.

Wet suction. Describe.

Has water. Is regulated by the height/level of the water (sterile fluid) in the suction-control chamber. A suction pressure of ‑20 cm H2O is standard. Normal to have constant bubbling. Monitor the fluid level and add fluid as needed to maintain the prescribed level of suctioning. When working properly, what will you see in this chamber?

A 64-year-old woman is admitted to your medical-surgical unit with severe heart failure and dyspnea. Her chest x-ray shows a large pleural effusion on the left side, so the physician asks you to prepare her for chest-tube insertion. Your patient is alert and oriented, and she responds appropriately. You talk with her about the procedure and answer her questions. Which of the following should you do first when preparing to assist with chest-tube insertion? A. Arrange the closed-chest drainage system. B. Set up the suction source and tubing. C. Check the medical record for a signed informed consent.

C. Check the medical record for a signed informed consent. It is important to verify that the physician has obtained informed consent before you assist with any invasive procedure. Note the details of the informed consent, including the patient's name, the procedure, and the reason for the procedure. If you do not see the appropriate documentation of informed consent, contact the physician immediately to avoid further delaying of the required intervention.

What are the nursing responsibilities during chest tube insertion?

Position patient Support patient to minimize movement. Pre-medicate for pain.

When palpating around the chest insertion site, a cackling sound is heard. What does this mean?

This is a sign of subcutaneous emphysema. That air is trapped in the tissues beneath the skin. A possible cause of this is a poor seal at the chest-tube insertion site.

What is the overall goal of closed chest drainage?

To remove/drain air and fluid from the pleural cavity of the chest. Prevent air or fluid from re-entering the pleural space. Re-establishes the usual intrapleural and intrapulmonic pressures (negative pressure) in the pleural space, allowing the lung to re-expand. Promote lung re-expansion. Restore adequate oxygenation and ventilations. Prevent complications.

What are the nursing interventions if the tubing has disconnected from the drainage unit?

- Identify the problem. - Check the patency of the chest tube. Look for loose connections between the patient and drainage system. - Instruct the patient to exhale and cough to rid the pleural space of as much air as possible. - Submerge the end of the chest tube in 1 inch of sterile water until you can cleanse the tips of the tubing and reconnect them quickly. - Tighten any loose connections and tape them securely or use a locking plastic tie.

Suction control chamber

Hemlich valve Negative pressure applied to suction in order to remove air and fluid from pleural cavity. - Expected finding is continuous bubbling in chamber. - Used to enhance re-expansion of lung quickly. Sterile water is placed in chamber to about -20 cm line or prescribed amount.

How can you tell that the patent's mobile one-way valve is functioning?

Look at the inner valve. It should move with expiration, indicating that air is moving through the device. Also, the patient should be able to breathe without distress.

Chest tube complications

- Bubbling in the water seal chamber - leak in the system. Assess where the leak is by checking all connections and dressing, let physician know if continuous. - Increasing shortness of breath - assess patient and tube, is tube kinked or clamp (if so undo), is there tidaling. - Chest tube becomes disconnected from system - place tube in 250 ml bottle of sterile saline. Clean ends with alcohol swabs or CHG swabs. -Air leak (continuous rapid bubbling in the water seal chamber) -No tidaling in water seal chamber -No bubbling in suction control chamber -Chest tube accidentally pulled from chest - Chest tube malposition - Re-expansion pulmonary edema - Vasovagal response w/ symptomatic hypotension - Infection at skin site - Pneumonia - Shoulder disuse

What are the nursing interventions if a chest tube is completely dislodged?

- Cover the site immediately with a sterile gauze dressing. - Make sure the dressing is not occlusive. - Stay with the patient and monitor his vital signs while another staff member notifies the physician. - Observe for signs of a tension pneumothorax, hypotension, distended jugular veins, absent or decreased breath sounds, tracheal shift, hypoxemia, weak and rapid pulse, dyspnea, tachypnea, diaphoresis, and chest pain. - Make sure the equipment for chest-tube insertion and emergency equipment are nearby. - Insert a new one.

What are the nursing interventions if there is an air leak?

- Identify the problem. Is determined by excessive and continuous bubbling in the water-seal chamber or the air-leak meter, especially if the system is connected to a suction source. - Check the patency of the chest tube. Look for loose connections between the patient and drainage system. - Using rubber-tipped clamps, try to locate the leak by clamping the tube momentarily at various points along its length. Begin at the tube's proximal end, near the dressing. Look at the water-seal/air-leak meter chamber. - If the bubbling stops, the air leak is at the chest-tube insertion site or inside the chest. - Examine the chest-tube insertion site quickly to see if the dressing is loose or the tube is dislodged. If the dressing is loose, air may be entering around the tube as the patient inhales. - Palpate around the chest tube site and listen for a crackling sound indicating subcutaneous emphysema, which can result from a poor seal at the chest-tube insertion site. - Ask the patient to cough to rid the pleural space of as much air as possible, apply an occlusive dressing or reinforce the dressing if it is intact, and monitor the patient to see if oxygenation improves. - The sound of hissing air, a large amount of new drainage at the insertion site, or visibility of the drainage holes at the proximal end of the chest tube suggest that the tube has dislodged. - Notify the physician immediately and prepare for another chest-tube insertion. Have emergency equipment (oxygen, resuscitation cart, chest- tube insertion kit) nearby including a flutter (Heimlich) valve or a large-gauge needle for an emergency thoracostomy.

What to think of when transporting the patient with chest tube.

- Keep the drainage device below the patient's chest and disconnect the system from the suction source. - Check your facility's policies to see if the physician must first prescribe discontinuing suction for transport. - Some closed-chest drainage systems and suction devices contain a vent from the water-seal chamber which allows the drainage unit to remain vented without suction if the exit vent is open. - Disconnect systems without an exit vent from the suction source before turning it off to prevent a tension pneumothorax.

Interventions to avoid potential complications associated with closed-chest drainage and post-tube removal.

- Keep the head of bed at 30 degrees or higher. Fowler's or high-Fowler's position while in bed facilitate lung expansion. - Remind or assist the patient to change position at least every 2 hr. - Help him ambulate every 4 to 6 hr during the day when allowed to enhance lung expansion and drainage. - Administer pain medication so that he can participate in deep breathing, incentive spirometry, and activities of daily living. - Replace the dressing on a regular schedule, or when necessary, using surgical asepsis. - Maintain a closed system by securing all connections. - Secure the chest tube to the chest wall so that it doesn't dislodge during activity. - Develop a schedule for dressing changes and routine position changes to promote drainage and ventilation. - Prevent kinking or occlusion of the chest tube during activity. - Encourage the patient to cough frequently and breathe deeply to help drain the pleural space, expand the lungs and help minimize pain. - Encourage active or provide passive range-of-motion exercises for the patient's arm on the affected side. - Tell the patient to report breathing difficulty immediately. Notify the physician if the patient develops cyanosis, rapid or shallow breathing, subcutaneous emphysema, chest pain, or excessive bleeding. - Observe the patient during ambulation and activities to ensure that the chest tube remains free of kinks and occlusion.

What are the nursing interventions if a chest tube disconnects from a closed-chest drainage system?

- Quickly clamp the tube as long as there is no bubbling in the water-seal/air-leak meter. - Use a disinfectant to clean the end of the chest tube and the reattachment site and re-establish the connection. - If there is bubbling in the water-seal/air-leak meter and your assessment has determined that there is an air leak from the chest, submerge the distal end of the tube in 1 inch of sterile water to create a temporary water seal while you prepare the system for reattachment or replacement. Do not clamp the chest tube as this will cause air to accumulate in the pleural cavity with no means of escape, which can rapidly lead to a collapsed lung and tension pneumothorax, a potentially life-threatening event.

Monitor the patients frequently for....?

- Vital signs - Respiratory status - Lung sounds, rate, etc - Skin colour - Pain - Check chest tube insertion site and dressing atleast every 4hrs. Use of surgical asepsis is essential. - Palpate for crepitus/subcutaneous emphysema -like a rice crispy feeling around the site. Result of small amount of air in the skin, indicates air leakage. Best way to document how big is to draw it with a marker. Often dissolves by itself.

Nursing Responsibilities. Identify the steps involved in removing a chest tube.

Medicate patient prior to removal. Have occlusive dressing ready. Instruct patient on Valsalva maneuver. Monitor patient for return of pneumothorax.

Which patient is potentially at risk for a spontaneous pneumothorax?.

A tall patient that smokes.

Your patient is a 45-year-old man with a chest tube in place to treat a left-sided hemothorax that resulted from a motor-vehicle crash. The closed-chest drainage unit has a water seal and is set to suction at -20 cm of water. The physician inserted the chest tube 4 hours ago; the total drainage so far is 300 mL. You enter the room and find your patient standing at the bedside. The chest tube is on the bed, and you see dark blood oozing from the insertion site. He tells you it came out while he was getting out of bed and reports pain and burning at the insertion site. Which of the following should you do first? A. Apply an occlusive dressing over the chest-tube insertion site. B. Prepare for another chest-tube insertion. C. Assist the patient back into bed in high-Fowler's position. D. Assess the rate, depth, and quality of the patient's respirations.

A. Apply an occlusive dressing over the chest-tube insertion site. Your patient is bleeding and is at immediate risk for air entering the pleural cavity as he inhales. So you should apply dry gauze to the chest-tube insertion site immediately while a colleague contacts the physician. Then seal the dressing with occlusive material, but tape it in place on three sides only. This allows air to escape through the wound but prevents air from entering through the wound when the patient inhales. Air that cannot escape can cause a tension pneumothorax, and air that enters through the wound can worsen the existing pneumothorax.

You confirm the integrity and function of the drainage system and then proceed to arrange for a portable chest x-ray to confirm the position of the chest tube. The tube could damage pleural tissue if the physician inserted it too deeply, and it could cause an air leak if he did not insert it far enough. Meanwhile, you make sure the patient understands that she has to turn from side to side in bed every 2 hours to promote fluid drainage from her left lung. Two hours later, you and a nursing assistant approach your patient's bedside to help with her next turn. While you are holding the patient in place, the nurse assistant trips over the closed-chest drainage system, disconnecting the chest tube from the collection chamber port and knocking the closed-chest drainage system over. The chest tube itself remains in place. Which action should you take first? A. Ask the patient to exhale fully and cough. B. Reconnect the chest tube to the collection chamber port. C. Clamp the chest tube near the insertion site. D. Disinfect the end of the chest tube.

A. Ask the patient to exhale fully and cough. This action will help rid the pleural cavity of any remaining air and will retain negative intrapleural pressure while you attend to the chest tube.

You measure your patient's respiratory rate and find it within the expected reference range. The depth and quality of her respirations show improvement, as they are now even and unlabored. Which action should you take next? A. Auscultate the patient's breath sounds. B. Arrange for a portable chest x-ray. C. Check the connections and functioning of the closed-chest drainage system.

A. Auscultate the patient's breath sounds. As you continue assessing your patient after this invasive procedure, you auscultate her breath sounds to collect data about the quality of airflow through her lungs. You might continue to find diminished breath sounds on the affected side until or unless her lung can expand fully.

You check all connections and find them tight and secure. What should you do next? A. Cross-clamp the chest tube close to the patient's chest. B. Move the clamps down the drainage tubing. C. Replace the tubing or secure the connection

A. Cross-clamp the chest tube close to the patient's chest. If the bubbling in the water-seal chamber stops, the air leak is at the insertion site or within the patient's thorax. If it stopped, you'd release the cross-clamp, reinforce the chest dressing, and notify the physician immediately. Leaving the chest tube clamped can cause a tension pneumothorax and a mediastinal shift.

Clamping the chest tube has no effect, so you proceed to your next troubleshooting step. What should you do next? A. Move the clamps down the drainage tubing. B. Replace the tubing or secure the connection

A. Move the clamps down the drainage tubing. Using two clamps, gradually move them one at a time down the drainage tubing away from the patient and toward the drainage chamber. When the bubbling stops, you'll know that the leak is in the section of tubing distal to the clamp. You can then replace the tubing or secure the connection and release the clamp.

Patient Education - What does your patient need to know?

Activity/restrictions - turns every 2hrs. Monitor lung sounds. Keep the drainage system below chest level and not to disconnect the tubing. Turning, coughing, deep breathing. Incentive spirometer. How long the tube will be in place. Depends on patient, some may be able to take off with 2 days others longer. How does the physician know when it's time to pull the tube? Assessments, lung sounds, chest x-ray.

Apply the nursing process when providing care to the patient with closed-chest drainage.

Assess - (document) vital signs, respiratory status, oxygen saturation, pain, skin colour, difficulties breathing, level of consciousness, temperature, rate of capillary refill in extremities, insertion site, ability to ambulate, drainage function etc. Plan - Strategies to optimize ventilation and oxygenation such as positioning, pain management, and activity. Plan proper care of the chest-tube insertion site and closed-chest drainage system and patient education. Implement interventions Evaluation - Expect lung sounds to be clear bilaterally with a symmetric chest rise on inhalation. The patient's skin should remain pink and warm and have a quick rate of capillary refill. The patient should be able to ambulate and perform activities without complications, and his level of endurance should increase over time.

You assist the patient to roll onto his unaffected side. Which of the following should you do next? A. Coil the tube so it does not drag behind the patient. B. Ask the patient to swing his legs around while you move the tube.

B. Ask the patient to swing his legs around while you move the tube. Have your patient use the side rail to swing his legs around to the side of the bed while he pushes himself into a seated position. Stand on his side near the chest tube so that you can keep the tube out of the way of his legs and feet. Finally, coil the tubing to keep it out of his way as he ambulates and to keep it from kinking or becoming occluded. Remember to keep the tubing below the insertion site to facilitate drainage.

The signed consent form is in place, so you prepare the supplies and equipment for the procedure. The physician inserts the chest tube without any complications. You apply an occlusive dressing to the chest-tube insertion site and note serosanguineous secretions draining into the collection chamber. Which action should you take first? A. Auscultate the patient's breath sounds. B. Assess the patient's rate, depth, and quality of respirations. C. Arrange for a portable chest x-ray. D. Check the connections and functioning of the closed-chest drainage system.

B. Assess the patient's rate, depth, and quality of respirations. Before, during, and after any invasive procedure, your priority is to assess the patient. Because this procedure treats the patient's altered respiration, begin your assessment by evaluating the patient's ability to ventilate and oxygenate. These parameters are the most immediate way to collect essential data about her response to the closed-chest drainage system and to identify any indications of problems with the system.

The physician re-inserts the chest tube without complications. The chest tube is intact with an occlusive dressing in place, and you note another 250 mL in the collection chamber. The patient is in high-Fowler's position and his respirations are within the expected reference range. Now that he is stable, you assess the functioning of the closed-chest drainage system and tell him you'll return check on him periodically and in 2 hours to help him change position. As you help your patient turn toward his left side 2 hours later, you notice a sudden gush of drainage into the collection chamber. What should you do first? A. Inspect the color and consistency of the drainage fluid. B. Assess the rate, depth, and quality of the patient's respirations. C. Measure the amount of drainage fluid in the collection chamber. D. Monitor for excessive drainage or the presence of frank blood

B. Assess the rate, depth, and quality of the patient's respirations. A sudden gush of drainage is often retained blood and not active bleeding. However, if the patient is actively bleeding, expect to see a change in his status, such as increased respiratory effort as blood fills the pleural space. The absence of respiratory distress increases the likelihood that the drainage was retained fluid that escaped due to the position change. Once you have verified that your patient is stable, examine the drainage to collect further data.

After 3 days of closed-chest drainage to treat the pneumothorax, the physician determines that the patient is stable enough for chest-tube removal. To prepare your patient for this procedure, you administer pain medication. Then, after it has taken effect, which action should you perform next? A. Ask the patient to lie on his unaffected side. B. Show the patient how to perform Valsalva's maneuver. C. Apply an occlusive dressing.

B. Show the patient how to perform Valsalva's maneuver. Have the patient practice performing Valsalva's maneuver gently by exhaling completely and bearing down. Doing this immediately before chest-tube removal maintains negative pressure in the pleural cavity during removal, preventing air from entering the pleural space. After he knows how to do it, position him for the procedure.

Over the next 2 hours, the amount of chest tube drainage decreases. After returning to your patient's room for his hourly assessment, you notice that the drainage has ceased. When you inspect the closed-chest drainage system, you observe continuous bubbling in the water seal chamber. What should you do first? A. Cross-clamp the chest tube close to the patient's chest. B. Move the clamps down the drainage tubing. C. Assess all connections between the patient and drainage system. D. Replace the tubing or secure the connection.

C. Assess all connections between the patient and drainage system. Continuous bubbling in the water-seal chamber indicates an air leak somewhere between the patient and the water seal. First, tighten any loose connections and then recheck the water-seal chamber for continuous bubbling. A loose connection is a common source of an air leak and is easy to remedy.

You inspect the tubing and find that the bedrail has clamped a section of the chest tube. You release the tube, and your patient stabilizes. His vital signs return to the expected reference range, and his oxygen saturation returns to 98%. After giving him some time to recover, you encourage him to use the incentive spirometer. Which of the following should you do first? A. Administer pain medication. B. Assist him into high-Fowler's position. C. Assess his level of pain. D. Teach him how to use incentive spirometry.

C. Assess his level of pain. Assessment is the first step of the nursing process, so, yes, you should assess the patient's pain level routinely and especially before he performs activities. If he has pain, you'd administer the prescribed PRN analgesia and allow time for it to take effect. That way, he will perform the required activity optimally and comfortably.

How is a pneumothorax or hemothorax diagnosed?

Chest x-ray

What are the various types of closed-drainage chest tube systems?

Closed-Chest Drainage Units - sealed drainage system. Heimlich Valves - one-way valve.

What are the indications for closed-chest drainage?

Collection of fluid in the pleural cavity due to trauma to the chest or a disease process (With severe heart failure, transudates and exudates accumulate. Liver cirrhosis and pulmonary malignancies increase the likelihood of pleural effusion). Pneumothorax - collapsed lung. Occurs when air leaks into the space between the lung and the chest wall and pushes on the outside of the lung. Tension pneumothorax - develops when air is trapped in the pleural cavity under positive pressure, displacing mediastinal structures and compromising cardiopulmonary function. Hemothorax - collection of blood in the pleural space. Chylothorax - leakage of lymph fluid from the thoracic duct into the pleural cavity. Empyema - a high-protein exudative effusion (collection of pus) resulting from infection in the pleural space. Surgical reasons - e.g. after a thoracotomy, extensive cardiovascular surgery or §any kind of lung surgery.

Closed-Chest Drainage Units

Consists of 3 chambers. 1. Fluid collection chamber 2. Water seal chamber 3. Suction control chamber All three chambers are essential when using a controlled suction source to draw air or fluid out of the pleural space.

The patient does well with incentive spirometry. He tells you he feels better and would like to get out of bed and walk around the room. Which of the following should you do first to prepare your patient for ambulation? A. Coil the tube so it does not drag behind the patient. B. Have the patient log roll onto his unaffected side. C. Ask the patient to swing his legs around while you move the tube. D. Check to see that the chest tube is firmly secured to the patient's chest wall.

D. Check to see that the chest tube is firmly secured to the patient's chest wall. If the chest tube is not secured directly to the chest wall, any movement might cause pulling at the insertion site. Since the chest tube is typically secured with a single suture, even slight pulling can cause pain and could dislodge the tube.

Dry suction. Describe.

Has no water. Allow for higher suction pressure levels. Is regulated by a self-compensating regulator, or automatic control valve that continuously balances the force of the suction with the atmosphere. Normal to have gentle bubbling. Advantage: allows the system to respond and adjust to changes in air leaks and fluctuations in the suction source vacuum to deliver accurate suction pressure. What will you see with these that's different than wet suction?

Your patient is a 23-year-old man with a chest tube in place to treat a large spontaneous pneumothorax. While you are receiving report, his call light goes on. When you enter his room, you see that he is having difficulty breathing. His jugular veins are distended, he is pale and sweaty, and his trachea has shifted to the right. You immediately tell your colleague to notify the surgeon. Your patient is alert and oriented but appears very anxious. He is gripping the side rails of the bed with both arms and leaning forward. On auscultation, you cannot hear any air movement over the entire lung field on the right side. His oxygen saturation is declining and is currently at 84%. Which of the following should you do first? A. Assess the dressing over the chest-tube insertion site. B. Verify the function of the closed-chest drainage system. C. Prepare for another chest tube insertion. D. Inspect the tubing for any kinks or occlusion.

D. Inspect the tubing for any kinks or occlusion. If the tubing is kinked or occluded, the system could be trapping air in the intrapleural space. Look over the entire length of the tubing, paying special attention to the connections. If a kink is causing the problem, it is quick and easy to correct it.

Fluid Collection Chamber

Fluids drain from the chest tube into this chamber. Nothing is done with the drainage, just mark it to keep track. Do not change unless necessary, because of risk for infections.

What does the water seal chamber do?

It measures the amount of negative pressure in a patients cavity. When a patients inhales the negative pressure in the lungs and pleural space increases. A rise in the calibrated chamber indicates the increase. Water levels rises and falls as patient breathes. Wothout suction, negative pressure is read directly from the calibrated chamber.

Should the chest tube be clamped during transportation to another unit?

No, because clamping puts the patient at risk for a tension pneumothorax. It's acceptable to clamp it very briefly when replacing the drainage system or looking for an air leak but not during transportation. Be sure to keep the drainage system upright and below the level of the patient's chest so that it functions properly during transportation and ambulation. Also, disconnect the outside suction source and make sure the air vent is open.

Heimlich Valves

One-way flutter valve. Used to evacuate air. Also prevents air from re-entering the chest cavity with inhalation. For patients with small or partial pneumothorax. Does not collect fluid. Expect to see movement in the valve on exhalation as air or fluid exits from the patients pleural cavity. Advantages: Easier for the patient (no big drainage unit). Allows more mobility. Disadvantages: Serious complications if applied incorrectly.

Water seal chamber

Serves as a one-way valve, that allows air out, but not in. Able to measure intrathoracic pressure - the amount of negative pressure within the patients chest cavity. Bubbling is normal initial 48 to 72 hours. But continuous bubbling in the water-seal chamber indicates an air leak. Tidaling (expected to rise with inspiration, fall with exhalation, if there is no air leaks). If the patient is receiving positive-pressure ventilation, the fluid level falls with inhalation and rises with exhalation. - Contains 2 cm of sterile water, which acts as a one-way valve. - Air enters from the collection chamber and bubbles up through the water. - The water prevents backflow of air into the patient from the system. - Bubbling occurs initially when a pneumothorax is evacuated. With normal use, it occurs intermittently during exhalation, coughing, or sneezing due to an increase in the patients intrathoracic pressure. - Tidaling; normal fluctuation of water that reflects the intrapleural pressure during inspiration and expiration. As the source of air in the pleural space gets smaller, it will take more and more positive intrapleural pressure to force air out. - Eventually, the air leak will seal and the lung will be fully expanded

Maintenance of the Chest Tube

When monitoring the patient's chest tube and CDU, do not clamp the chest tube, unless... Keep tubing below the chest at all times. Monitor frequently; - that all connections are tight. - for tidaling (expect to see 5 to 10 cm (2 to 4 inches) of fluctuation, reflecting pressure changes in the pleural space during respiration) - air leaks - may indicate an accidental dislocation of the chest tube at the insertion site, or possible external leaks at the tubing connection sites. - drainage - what it looks like, how much was on shift. And document - what site looks like, what the drainage looked like, how much there was, if there was air leak.