Chest Tubes Tbl 28-21

cdunbar4's version from 2017-03-02 04:19

Set-Up and Insertion

Question Answer
Step 1 (before you do anything)make sure pt. is aware of procedure & informed consent is obtained
Step 2: Equipment that you need to gatherThoracotomy tray; CDU; chest tube; bottle of sterile water; 1% lidocaine; suction tubing & collection container; occlusive dressing
Step 3: Prepare CDU for wet suction (where do you add water and how much?)add sterile water to 2-cm mark in water seal chamber and to 20cm mark in suction control chamber
Step 3: prep CDU for dry suction (where and how much water do you add?)add sterile water to fill line of the air leak meter. Attach suction tubing and ↑ suction until the bellows-like float moves across the display window
Step 4position and support patient to minimize movement during procedure

Drainage System

Question Answer
How should the tubing be handled or stored while in place?keep tubing loosely coiled below chest level; drop straight from bed or chair to drainage unit; do not let it be compressed
Keep all connections b/t chest tubes, drainage tubing & drainage collector ______ and _____ at the connections.tight; tape
Observe for ____________ and _________ in water seal chambertidaling; bubbling
If tidaling is not observed with inspiration & expiration, what may be occurring?System is blocked, lungs are re-xpanded or the system is attached to suction
If the bubbling increases in the water-seal chamber, what is going on?there may be an air leak in the drainage system or a leak from the patient (bronchopleural leak)
Suspect a system leak when bubbling has what characteristics?continuous bubbling
Interventions for leak in system (continuous bubbling)retape tubing connections; ensure dressing is air-occlusive; clamp near chest briefly to see if air is coming from patient; if leak persists, briefly move clamps down tubing away from patient until air leak stops.
Where is the leak located if you are using the clamp down the tube method?between the last two clamp points.
If the leak is all the way to the drainage unit, what should you do?You will need to replace the unit.
What do high fluid levels in the water seal indicate?Residual negative pressure.
What needs to happen to the system if there are high fluid levels in the water seal?may need to be vented by using the high-negativity release valve available on the drainage system to release the residual pressure.
What should you not do when wall suction is not operating or when the patient is on gravity drainage?Lower the water-seal column

Patient's Clinical Status

Question Answer
Monitor patient's clinical statusassess VS, lung sounds, pain
Manifestations of reaccumulation of air and fluid in the chest↓ or absent breath sounds, significant bleeding (>100mL/hr), chest drainage site infection, poor wound healing. Notify PCP.
Evaluate for ____________ ____________ at chest tube site.subcutaneous emphysema
Encourage pt. to _______ __________ periodically to facilitate lung expansion & encourage ______-___-_________ exercises to the shoulder on the (affected or unaffected?) side.breathe deeply; range of motion; affected
What should be encourage for the patient to use every hour when awake to prevent atelectasis or pneumonia?Incentive Spirometry

Chest Drainage

Question Answer
What should you never to that will cause fluid to drain back into the patient's lungs?Elevate system to the level of the pt's chest.
If the collection chamber is full, should you try to empty it?No, just change the entire unit.
Marking the measurement of drainage and times is done according to unit standards. What characteristics should be reported?any change in quantity or characteristics of drainage (clear yellow to bloody) →notify PCP & record change.
If drainage is >____ml/hr. notify PCP100
Check the position of chest drainage container. If drainage system is overturned, what important aspect is disrupted?The water seal chamber; return to upright position and tell patient to take a few deep breaths, followed by forced exhalations and cough maneuvers.
What should you do if the drainage system breaks?place distal end of chest tube connection in sterile water container at a 2cm level as an ER water seal.
What is no longer recommended?milking or stripping chest tubes as it can increase intrapleural pressures and damage lung tissues. But, if ordered, do it GENTLY.

Monitoring Wet vs. Dry Suction Chest Drainage

Question Answer
Suction control in dry suction systemonce connected to pt. turn dial on chest to about -20cm pressure; connect tubing to wall suction source & increase suction until correct pressure is indicated.
If there is an order to decrease suction in a dry suction system....turn the dial down, depress the high-negativity vent & assess for a rise in the water level of the water-seal chamber.
Suction control chamber in wet suction systemkeep suction chamber in control by adding sterile water as needed to replace water lost to evaporation
Wet suction: why should you keep the muffler covering the suction control chamber?to prevent more rapid evaporation of water and decrease the noise of bubbling
After filling the suction control chamber to the ordered amount, where do you connect the suction tubing?to the wall suction
Dial the wall suction regulator until what is seen in the suction control chamber?gentle bubbling (80-120mmHg). vigorous bubbling isn't necessarh
If no bubbling is seen in the suction control chamber, one of 3 things could be happeningthere is no suction; suction is not high enough; or the pleural air leak is so large that suction is not high enough to evacuate it.

Chest Tube Dressings

Question Answer
When removing old dressing, be care to avoid removing ________ ______ ______.unsecured chest tube. Assess insertion site, cleanse according to protocol
How to redress the sitecleanse according to protocol; maintain asepsis; redress with occlusive dressing such as Opsite or gauze with occlusive tape.

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