Parts of a Chest Tube Drainage System:
>collection chamber - ANS -collects fluid with air passing through
-allows fluid volume up to 2,000 mL
>this allows for assessment of type of drainage, amount of drainage, & rate changes (& some have a sampling port)
Parts of a Chest Tube ...
482- Complex II Exam 1; Module 2
(Respiratory Disorders) Questions And
Answers
Parts of a Chest Tube Drainage System:
>collection chamber - ANS -collects fluid with air passing through
-allows fluid volume up to 2,000 mL
>this allows for assessment of type of drainage, amount of drainage, & rate changes (& some
have a sampling port)
Parts of a Chest Tube Drainage System:
>water seal chamber - ANS -prevents air from going back into the pt
>one-way valve action that prevents air from returning to the chest while allowing air removal as
in pneumothorax
-filled to the -2 cm H2) level that maintains a slight negative pleural pressure & prevents air
entering the pleural space when off suction & on water seal
Parts of a Chest Tube Drainage System:
>suction control chamber - ANS -allows suction level settings depending on the medical
condition
-can be either dry suction or a water-filled chamber
>dry suction chamber: uses mechanical system that allows the set suction level to be
maintained regardless of the external suction level applied
>water-filled chamber: set by adjusting water level; w continuous high suction. evaporation
occurs & changes volume of water that changes suction level...nursing roles- assess water level
daily w suction off to refill chamber to desired level
What are the different indications for placing a chest tube? - ANS >HEMOTHORAX:
-chest trauma
-neoplasms
-pleural tears
-excessive anticoagulation
-postthoracic surgery/open lung biopsy
>PNEUMOTHORAX (spontaneous: >20%):
-bleb rupture
-symptomatic pt
-presence of lung disease
,>TENSION:
-mechanical ventilation
-penetrating puncture wound
-prolonged clamping of chest tubes
-lack of seal in chest tube drainage system
>BRONCHOPLEURAL FISTULA:
-tissue damage
-tumor (esophageal cancer)
-aspiration of toxic chemicals
-boerhaave syndrome (spontaneous rupture)
>PLEURAL EFFUSION:
-neoplasms
-cardiopulmonary disease, CHF
-inflammation condition
-recurrent infections/pneumonia
>CHYLOTHORAX:
-trauma/thoracic surgery
-malignancy
-congenital abnormalities
Bubbling vs. constant bubbling in chest tube - ANS >bubbling should be seen only in the
underwater seal chamber during expiration (or during inspiration w positive-pressure ventilation)
as air & fluid drain from the pleural cavity
>constant bubbling indicates an air leak in either the system or a bronchopleural fistula
What happens during chest tube placement? - ANS -small incision is made
-hemostat/forceps are used to penetrate the pleural space
-tract is dilated w sterile, gloved finger
-proximal end of tube is clamped w hemostat & inserted into pleural space
-distal end of tube is connected to chest drainage unit after insertion
>ends of both the chest tube & drainage system tubing must remain sterile as they're connected
-tube is sutured to the skin around the insertion site to prevent dislodgement
-4x4 drain sponge is positioned over tube & tape occlusively to chest
-all connection from insertion site to drainage collection is securely taped to prevent air
leaks/disconnections
~*chest xray* is ALWAYS ordered to confirm positioning
~lungs auscultated; condition of tissue around site is assessed for present of subq air
What is the nurse's role during the chest tube placement process? - ANS -prepare the
pt/family for procedure & answer any questions
-prepare pt physically; insertion can be painful, so analgesics are typically given
-place pt in FOWLER's/SEMI-fowler's
>chest tube output is assessed every 2 hr the nurse looks for sudden cessation of drainage or
an increase to more than 200 mL/h, or sudden change in the character of the drainage
,What are nursing priorities in the care of a patient with a chest tube? - ANS -care is
directed at maintaining patency & proper functioning
Assessment and Management of a Patient with a Chest Tube - ANS -drain the latex tubing
frequently into collection container (~every 2 hr)
-coil the latex tubing loosely on the bed to prevent kinks or pooling of blood/drainage in a
dependent loop hanging on the floor
-ensure pt doesn't lie on tubing
-NEVER raise drainage system above the chest
-check for drainage, suction level & water seal integrity at frequent intervals
-secure system to foot of bed or tape it to the floor to avoid accidental overturning & possible
reaccumulation of the pneumothorax
-inspect all tubing connections for leaks & secure them w tape to prevent disconnection
Drainage Monitoring of Chest Tubes - ANS -assess & document the color, consistency, &
amount of drainage while remaining alert to significant changes
>a sudden increase indicates hemorrhage or sudden patency of a previously obstructed tube
>a sudden decrease indicates chest tube obstruction or failure of the chest tube or drainage
system
The following nursing actions are recommended to reestablish chest tube patency and
troubleshoot an obstruction in the chest tube: - ANS -attempt to alleviate the obstruction
by repositioning the pt
-if the clot is visible, straighten the tubing between the chest & drainage unit & raise the tube to
enhance the effect of gravity
>studies suggest that milking & stripping techniques may NOTTT be beneficial for maintaining
chest tube patency; they can excessively increase intrapleural/intrapulmonary pressures,
affecting ventricular function or causing trauma from aspiration of lung tissue into chest tube
eyelets...but may be necessary if HCP states its use for active bleeding to prevent blood clotting
in the tubing that can lead to cardiac/pleural tamponade
Describe water seal monitoring: - ANS -monitoring the water seal of the chest tube is
JUST as important as observing the drainage
-visual checks are made to ensure water seal chambers are filled to the 2-cm water line
-if suction is applied, the nurse ensures the water line in a water-controlled suction chamber is
at the ordered level (typically -20cm H2O), bc water evaporates over time decreasing amount of
suction being applied
-!!!only apply STERILE water to the system!!!
-air vent opening should never be occluded
-suction tubing is disconnected briefly to accurately assess water level in the chamber only after
clamping..then tubing is reattached & clamp is opened
>NEVER leave tubing clamped..it can lead to pneumothorax or buildup of fluid in the chest,
leading to respiratory distress
, -respiratory fluctuations are observed in water seal
Respiratory fluctuations are observed in the water seal chamber...
>absence of fluctuations can mean?
>continuous vigorous bubbling w/o suction can mean? - ANS >Absence of fluctuations
can indicate the lung is reexpanded OR there is an obstruction in the system
>Continuous vigorous bubbling in the water seal chamber, w/o suction, indicates continued
pneumothorax OR the tube has been displaced OR disconnected OR the drainage system is
damaged
~necessary to check entire system for disconnections & to inspect the chest tube to see if it is
displaced outside the chest
~in the setting of mechanical ventilation at high volumes/pressures, bubbling in a chest tube
system that persists may indicate a bronchopleural fistula when there is NO pneumothorax or
other known cause
Positioning for a Patient with a Chest Tube - ANS -the ideal position for a pt with a chest
tube is the semi-Fowler position
-turning the pt every 2 hr enhances air & fluid evacuation
-teach pt how to support or splint the chest wall near the tube insertion site using a pillow, bath
blanket, or arms firmly against the chest
-encourages coughing, deep breathing, & ambulation
>admin of pain meds before these exercises decreases pain & enhances lung expansion
Complications of Chest Tubes: - ANS -the most serious complication resulting from chest
tube placement is:
>TENSION PNEUMOTHORAX
~this can develop if there is any obstruction in the chest tube drainage system
*-clamping chest tubes as a routine practice predisposes pts to this complication!!!!*
-occasionally, the chest tube may become dislodged or be accidentally removed
>insertion site is quickly sealed off using petrolatum gauze covered w dry gauze & occlusive
tape dressing to prevent air from entering pleural cavity
How can the nurse help prevent the complication that can result from chest tube placement? -
ANS ~DON'T KEEP TUBE CLAMPED
-Clamping of chest tubes is recommended in ONLY two situations:
1. to locate the source of an air leak if bubbling occurs in the water seal chamber
2. to replace the chest tube drainage unt
>clamping is only MOMENTARY
-if the tube must be clamped, padded hemostats are used to avoid lacerating the vinyl chest
tube
What are nursing priorities during the transport of a patient with a chest tube? - ANS
-constant assessment is necessary to prevent inadvertent chest tube removal, resulting in
recurrent pneumothorax
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