Question

Please help answer these questions

Chest tube collection divice exercise

1. How does the chest tube collection device work?
2. How is the device set up
3. How does suction work with the device? How is it regulated?
4. What safety initiatives should the RN implement for a patient with chest tubes?
5. What assessment should be done for a patient with chest tube(s)?
6. What assessment should the RN do on the chest tube “system”?
7. What element s do you want to ensure are included in your patient’s plan of care?

a.

b.

c.

d.

e.

8. When would the RN clamp a chest tube?

Answer 1

(A chest tube, also known as a thoracic catheter, is a sterile tube with a number of drainage holes that is inserted into the pleural space. ... The chest tube is connected to a closed chest drainage system, which allows for air or fluid to be drained, and prevents air or fluid from entering the pleural space)

A chest tube drainage system is a sterile, disposable system that consists of a compartment system that has a one-way valve, with one or multiple chambers, to remove air or fluid and prevent return of the air or fluid back into the patient The traditional chest drainage system typically has three chambers

Always review what type of system is used in your agency, and follow the agency’s and the manufacturer’s directions for setup, monitoring, and use. In general, a traditional chest tube drainage system will have these three chambers:

Collection chamber: The chest tube connects directly to the collection chamber, which collects drainage from the pleural cavity. The chamber is calibrated to measure the drainage. The outer surface of the chamber has a “write-on” surface to document the date, time, and amount of fluid. This chamber is typically on the far right side of the system

Water-seal chamber: This chamber has a one-way valve that allows air to exit the pleural cavity during exhalation but does not allow it to re-enter during inhalation due to the pressure in the chamber. The water-seal chamber must be filled with sterile water and maintained at the 2 cm mark to ensure proper operation, and should be checked regularly. Fill with additional sterile water as required. The water in the water-seal chamber should rise with inhalation and fall with exhalation (this is called tidaling), which demonstrates that the chest tube is patent. Continuous bubbling may indicate an air leak, and newer systems have a measurement system for leaks — the higher the number, the greater the air leak. The water-seal chamber can also monitor intrathoracic pressure

Wet or dry suction control chamber: Not all patients require suction. If a patient is ordered suction, a wet suction system is typically controlled by the level of water in the suction control chamber and is typically set at -20 cm on the suction control chamber for adults. If there is less water, there is less suction. The amount of suction may vary depending on the patient and is controlled by the chest drainage system, not the suction source. Monitor the fluid level to ensure there is gentle bubbling in the chamber. A dry suction system uses a self-controlled regulator that adjusts the amount of suction and responds to air leaks to deliver consistent suction for the patient. If suction is discontinued, the suction port on the chest drainage system must remain unobstructed and open to air to allow air to exit and minimize the development of a tension pneumothorax

Safety considerations:

A chest tube may be inserted at the bedside, in procedure room, or in the surgical suite. Health care providers often assist physicians in the insertion and removal of a closed chest tube drainage system.

After initial insertion of a chest tube drainage system, assess the patient every 15 minutes to 1 hour. Once the patient is stable, and depending on the condition of the patient and the amount of drainage, monitoring may be less frequent. If the patient is stable (vital signs within normal limits; drainage amount, colour, or consistency is within normal limits; the patient is not experiencing any respiratory distress or pain), assessment may be completed every 4 hours. Always follow hospital policy for frequency of monitoring a patient with a chest tube.

Prior to managing a patient with a chest tube, review reason for the chest tube, the location of the chest tube, normal volume of drainage, characteristics of the drainage, date of last dressing change, and any previously recorded air leaks measurements.

Safety/emergency equipment must always be at the patient’s bedside and with the patient at all times during transportation to other departments. Safety equipment includes:

Two guarded clamps

Sterile water

Vaseline gauze (Jelonet)

4 x 4 sterile dressing

Waterproof tape

Never clamp a chest tube without a doctor’s order or valid reason. The tube must remain unobscured and unclamped to drain air or fluid from the pleural space. There are a few exceptions where a chest tube may be clamped; see special considerations below.

Chest tube drainage systems are replaced only when the collection chamber is full or the system is contaminated.

1. Review the patient chart for the reason for the chest tube and location and insertion date.
2. Perform hand hygiene. identify patient using two identifiers and explain assessment process to patient. Create privacy to assess the patient and drainage system.
3. Complete respiratory assessment, ensure patient has minimal pain, and measure vital signs. Place patient in semi-Fowler’s position for easier breathing.
4. Collection chamber (drainage system) is below the level of the chest and secured to prevent it from being accidentally knocked over.
5. Periodically check water-seal chamber to ensure water level is to the dotted line (2 cm) — at least once every shift. Add water as necessary
6. Check water-seal chamber for tidaling (water moving up and down) with respirations. Gentle bubbling is normal as the lungs expand.
7. Ensure suction control dial is set to ordered level (usually 20 cm).
8. Assess air leak meter to determine progress of patient’s internal air level, measured as level 1 to 7. On every shift, document the level of air leak, and if the air leak occurs at rest or with coughing
9. Check that the clamp is open.

When it is medically necessary to clamp the chest tube, clamp for no longer than one minute, to prevent increased pressure within the lung. If the chest tube accidentally falls out, instruct the patient to perform the Valsalva maneuver.