Transcript Chest Tubes - Faculty Sites

DEMONSTRATE THE ROLE OF THE RN IN
NURSING INTERVENTIONS OF CHEST TUBES
 PERFORM THERAPEUTIC NURSING
INTEVENTIONS TO CLIENTS WITH CHEST
TUBES

Where exactly is a chest tube placed?
The entry point is the fourth or fifth
intercostal space, on the mid-axillary
line. The tube is inserted towards the
collection: sometimes up and in front, or
up and in back, or wherever the
collection lies.
EDUCATE ON WHAT A CHEST TUBE IS TO
THE CLIENT
 ASSURE A CONSENT FOR PLACEMENT
WAS OBTAINED
 OBTAIN VITAL SIGNS PRIOR TO
PROCEDURE
 SET UP ROOM WITH CORRECT EQUIPMENT
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› WET VS DRY SYSTEM
 Chest
tubes are inserted to drain
blood, fluid, or air and allow full
expansion of the lungs.
› placed in the pleural space.
 The
area where the tube will be
inserted is numbed
 PLACE
THE CLIENT IN SEMI FOWLER’S TO
HIGH FOWLER’S
 The
chest tube is inserted between
the ribs into the chest and is
connected to a bottle or canister
that contains sterile water.
 Suction is attached to the system to
encourage drainage.
 A stitch (suture) and adhesive tape
is used to keep the tube in place.

Indications for pleural tube placement:
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Hemothorax
Pneumothorax
Pleural effusion
Empyema (drainage of pus)
Postoperative thoracostomy
Allows air to exit the chest and prevents air from
entering the chest
 Usually inserted at bedside
 There are two types of pleural tube connections

› Underwater seal drainage
› One-way valve
Indications for a mediastinal tube include drainage
of the mediastinal space after a surgical procedure,
cardiac surgery, and creating a pericardial window
 No tidaling will be observed with mediastinal tubes
due to their location in the mediastinal space as
opposed to the pleural space
 RN must ensure patency and unobstructed drainage
 Inserted in the operating room during surgery
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Gather the necessary equipment
Instruct client on procedure and expected outcomes
Check for allergies
Administer analgesia and sedation per order
Position client for insertion (semi-Fowlers to high
Fowlers depending on reason for insertion)
Assist physician with sterile field & apply mask to
self
Assist physician with insertion of chest tube
Place Vaseline gauze dressing around tube at
insertion site to prevent air from escaping
Finish with occlusive 4x4 gauze dressing
INSERTION
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ALL ABOUT
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Chest tube drainage systems act as a one-way valve
› Removes pleural drainage
› Increases intrathoracic pressure
› Decreases chest wall pressure
› Restores negative pressure in the lungs
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Types of chest tube drainage systems:
› Water seal
› Dry suction
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Water seal drainage system -› Suction is determined by the amount of water in the water
seal system and the amount of suction on the wall
› Gentle bubbling sound is expected
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Dry suction drainage system -› Closed, one-way drainage system
› Orange accordion-like object visible when suction
applied
› Wall suction controls the rate of air flow
› Thoracic pressure is determined by the pressure of
the wall suction and the level of the water in the
drainage system
The chest tube usually remains in place until the X-rays show that all the
blood, fluid, or air has drained from the chest and the lung has fully reexpanded.
Chest X-Ray
Showing a
Tension
Pneumothorax
See the shifted
mediastinum? –
the trachea’s
shoved over to
the right.
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Chest tubes are often connected to suction
› Increases drainage
› Assists lungs in achieving re-expansion
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Chest tube suction is typically set at 20cm (water
pressure)
Disconnecting the chest tube from suction does not
allow air to enter the chest, but does stop the suction
Indications for removal of chest tube include:
› Diminished chest drainage
› Frequent re-expansion of the lung
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Suction is usually discontinued for a few hours prior to
chest tube removal
When the chest tube
is no longer needed, it
can be easily
removed, usually
without the need for
medications to sedate
or numb the patient.
Medications may be
used to prevent or
treat infection
(antibiotics).
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Assess the client immediately after insertion and
every 4 hours thereafter
› Assess vital signs
› Check drainage appearance and amount
 Should be no greater than 100 mL/h
 Record at least every 8 hours
› Check chest wall at insertion site for subcutaneous
emphysema
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Observe for tidaling
› Check for kinks in the tubing if none noted
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If air bubbles in the air leak indicator are observed,
check entire tubing for air leaks
Ensure suction is set at the ordered level
 Make sure drainage system is positioned correctly
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› Upright and secured
› Below the level of the client’s heart
Ensure Vaseline gauze is available at bedside
 Make sure client has had a post-insertion x-ray
 Change the drainage system receptacle as indicated
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› Only when chambers are full
› Use sterile technique
Tidaling: the middle water seal chamber is observed
for expected rise in fluid level with expiration.
Air leak: noted when continuous bubbling is observed
in the main water seal chamber
Suction may be wet or dry
•A gentle bubbling sound is normal to hear with a
wet system
•Dry systems have a orange accordion looking
object visible when suction is applied
•Change the recepticle only when chambers are full
using sterile technique
•Heimlich Flutter Valve: air and fluid are expelled and
not rebreathed in
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This is a collection of pus in the
pleural space, or in a big
abscess space in the lung tissue
itself.
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Pus can collect in large enough
quantities to compress the lung,
and certainly will act as a septic
“focus” until it’s drained.
Empyema can result from chest
trauma - say, a gunshot or knife
wound - or necrotizing
pneumonia, or any other
process that puts bacteria into
the chest.
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Chest tube dislodgement -› At the chest:
 Quickly apply Vaseline gauze (depending on type) to the
chest insertion site
 Assess for respiratory distress
› At the drainage system unit:
 Clamp the chest tube while another nurse obtains a new
drainage unit
 Set up new drainage unit and connect to chest tube
 Attempt to complete this entire procedure in less than 1
minute to prevent complications
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Clamping a chest tube can result in high risk for
developing tension pneumothorax
› Risk is increased with positive pressure ventilation
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Assess for chest tube dislodgement at the chest via
placing stethoscope over dressing at insertion site
and auscultating for whistling sound
› Occurs when the chest tube port has dislodged from
the chest and is continuously sucking in air from the
surrounding atmosphere
› Stat x-ray indicated as air may be dangerously reaccumulating in the chest
You place the container back in the
upright position. Mark the chambers
where the blood is or replace chamber if
needed.
 Check the pt
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