Chest Tubes

VS, Respiratory status, O2sat level, proper functioning of system, lung sounds, pain

Assessment of Chest tube patient

can occur at the drainage site or with the drainage unit

Leaks

-Chest tube drainage system must be kept upright and below level of chest. Patient may move around with chest tube. Tubing is not clamped for transport, but must ask MD if can transport without suction. If chest tube pulled out the air can reenter the pleural space. Place occlusive dressing over the site to prevent air from reentering, however it does increase the risk of trapped air building up and placing pressure on the heart. Know MD preference. After chest tube removed monitor for crepitus and dressing site and respiratory status

Nursing care for chest tube drainage system

Risk for activity intolerance, deficient knowledge, acute pain, anxiety

Nursing dx for chest tube patients

sucking wound of the chest, the opening in the chest wall is large enough to allow air freely in/out of the thoracic cavity

Open pneumothorax

excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs. This excess can impair breathing by limiting the expansion of the lungs. Various kinds of pleural effusion, depending on the nature of the fluid and what caused its entry into the pleural space.

Pleural effusion

air can leak into the space causing displacement of the lung tissue and site can become contaminated

Potential complications if the chest tube dressing is not intact and occlusive

sudden onset of air into the pleural space with deflation of the affected lung

Spontaneous pneumothorax

Needle aspiration or chest tube drainage may be necessary to achieve re-expansion of the collapsed lung

Spontaneous pneumothorax <50% treatment

sometimes a suction source is used to speed lung reinflation. A separate bottle with tubing attached to suction is used. The amount of suction depends on the level of water in the bottle, not the amount of suction set on the machine. This is set by the MD and is almost always a negative 20 cm of water. The suction should be turned on far enough to cause gentle bubbling in the suction bottle or chamber. Vigorous bubbling causes water evaporation which alters the amount of suction.

Suction Chambers (general information).

buildup of air under pressure in the pleural space

Tension pneumothorax

close the chest would immediately, chest tube is inserted and water seal drainage set up to permit evacuation of fluid/air and produce re-expansion of the lung

Treatment of open pneumothorax

Immediate decompression to prevent cardiovascular collapse by thoracentesis or chest tube insertion to let air escape

Treatment of tension neumothorax

are fluctuations of the water level in the water seal chamber w/ inspiration and expiration a normal finding?

Yes

Chest tubes should never be clamped unless

changing the drainage system

this can indicate a leak in the drainage system

constant bubble in the water seal chamber after inital insertion

grating, crackling or popping sounds and sensations experienced under the skin and joints or a crackling sensation due to the presence of air in the subcutaneous tissue.

crepitus

catches fluid drained from the pleural space. Drainage may be from pleural effusion, chest trauma, or surgery. Sometimes small amount of drainage occurs because of the insertion of the tube. The drainage chamber is not emptied to measure drainage, rather drainage levels are marked and timed each shift to monitor the amounts and recorded on the I & O record every eight hours. If drainage becomes suddenly increased, notify MD.

drainage chambers

Patient may become tachypenic and hypoxic if this isnt working properly in your pt assessment w/ drainage tubes

drainage system not functioning properly

type of pleural effusion in which blood accumulates in the pleural cavity. This excess fluid can interfere with normal breathing by limiting the expansion of the lungs.

hemothorax

every shift

how often do we measure I/O of drainage

drainage system not working properly, sudden pain

indicators of potential complications in chest tube patients

these sounds may be diminished in the lung

over chest tube site

an abnormal collection of air or gas in the pleural space that causes an uncoupling of the lung from the chest wall. Like pleural effusion, pneumothorax may interfere with normal breathing. It is often called collapsed lung, although that term may also refer to atelectasis.

pneumothorax

discharge of fluid and blood

serosanguineous fluid

one thing you never open

the drainage system (lose negative pressure)

pleural tap, is an invasive procedure to remove fluid or air from the pleural space for diagnostic or therapeutic purposes. A cannula, or hollow needle, is carefully introduced into the thorax, generally after administration of local anesthesia. The procedure was first described in 1852.

thoraocentesis or thoracocentesis

pertaining to an alternating process, such as a rise-and-fall, ebb-and-flow, or periodic lapse of time.

tidaling

place the end of the chest tube into sterile solution

what do to if the chest tube accidentally becomes disconnected from the drainage system

assessments after removing DC chest tubes

Give pain med before removal, and continual assessment of respiratory status, RR O2sat, lung sounds and pain

Each time a patient exhales, air trapped in the pleural space travels through the chest tube to the water seal bottle or chamber, under the water, then bubbles up and out of the bottle. The water acts as a seal, allowing air to escape from the pleural space but preventing air from getting back in during the negative pressure of inspiration. Water in the tube fluctuates up with each inspiration and down with each expiration, as much as 5 to 10 cm. This is called tidaling. When the lungs reinflated, tidaling stops. If constant bubbling occurs in the water seal chamber, the system should be checked immediately for leaks

How a water seal chest drainage system works

used to drain fluid, used to drain blood, and used to remove air from the pleural space

Chest tubes

evolved from set of glass bottles to now a one-piece molded plastic system

Chest drainage systems