Chest Tubes Nursing Care Management Assessment NCLEX Review Drainage System

hey everyone say with register nurse Orion comm and in this video I'm going to be going over an an CLECs review about chest tubes what I want to do in this video is I'm going to cover the things you need to know exactly for the NCLEX exam I'm going to cover the anatomy the different types of drainage systems the purposes and the nursing interventions whenever you're maintaining these systems and after you watch this lecture be sure to go to my website register nurse Orion comm and take the free quiz that will test you on your knowledge about how to take care of chest tubes and a card should be popping up so you can access that so let's get started first let's start out talking about the purpose of a chest tube what is it and what does it do okay it is a tube that is inserted into the pleura space of the lungs to remove air or fluid to help re-expand the lung so let's look at what it does okay we have our lung here that is that little red area on the drawing then around the lung we have a little protective layer called the visceral pleura and then we have this small little space and then around that space that attaches to our thoracic cavity is called the parotid pleura and what happens is that whenever you breathe in and out these two layers glide gently over each other because in the pleura space there's a small amount of serous fluid that allows them to glide nice and gently to prevent them from rubbing together but while they're gliding they're creating a negative pressure which allows your lungs to work properly and to inflate and deflate now whenever something gets into this space like air or fluid the lungs are like oh no this is not right it's messing up our pressure setting because we have a negative pressure and it causes the lung to collapse so the physician will go in there and insert a chest tube to help drain out that air and that fluid that's called this lung issues now there is another type of chest tube which is um called a media Steindl chest tube and this is a tube that is inserted into the mediastinum space and it's typically placed under the sternum to drain fluid from around the heart after cardiac surgery because a lot of times after cardiac cardiac surgery there can be extra blood or fluid and this can get around the heart and compress it and send the patient into cardiac tamponade so those are placed as well now let's take it a little bit deeper and look at some other reasons why a chest tube might be placed okay the first one we hit on this is a pneumothorax and this is just where air enters into this small little space and causes the lungs to collapse this can happen because of like trauma or spontaneously happen I've had patients who've been admitted the doctor wasn't sure why they had a pneumothorax it just happened spontaneously another thing is called a pleura effusion and there's different types of pleura fusions depending on what type of fluid is in that floor space and what it is it's just fluid in the pleural space so here's your nice little space and some fluid gets in there messes up that pressure setting and the lung collapses and they have some major breathing issues okay different types of pleura fusions you have hemithorax which is where blood enters into the pleura space hemo means blood and this can be due to a trauma a disease like tuberculosis or a blood clotting issue they're not clotting so blood is leaking in there another thing is called a FEMA where they can get an infection in the pleura space and a last type of pleura fusion it's a silo thorax which is where lymphatic fluid can get into the pleura space and of course another reason for a chest tube is the cardiac surgery now let's look at the different types of chest tube drainage systems and whenever you get a job as a nurse be sure to familiarize yourself with the different types of chest tube drainage systems your facility offers and make sure you get a good end service on that because different places have different test tube drainage systems okay here are your basic ones I'm going to be going over and for in CLECs purposes the wet suction and the dry section and let me go over the basic setup of how a typical chest strain is set up and then we'll talk about the differences between the two okay so you have your little suction device the tube will go will be coming from the patient and this tube right here is from the patient it's draining down into the drainage chamber these are your drainage chamber where whatever is coming out of that line is flowing down into there then in the middle you have your water silk chamber and there's blue water in this and as the patient breathes in and breathe out this water will toss will tape up and down and sometimes there's a little ball in there that will move as well and then you have a little montaner leak monitor area and in this area you are looking for bubbling because if you see continuous bubbling which we'll go over in depth whenever I'm covering the nursing interventions and there could be an air leak and then over here at the very end you have your suction control chamber now notice on the wet suction and the dry suction it looks a little bit differently and that is the biggest difference with these two systems is the suction how the section works so let's cover it okay wet let's talk about the wet section okay the West section is regulated by the height of the water in the section control chamber when it's connected to wall sections so whenever you're setting up a wet section chest tube drainage you will be filling this with the water that it comes with and depending on what the physician orders you'll fill it up to whatever they order and typically it's negative twenty centimeters of water and this right here once you connect this tube to the wall section will regulate the suction control of the chest tube and you will hear bubbling and see gentle bubbling in this as it's working so that is normal now with dry suction the water there is no water column and the suction is controlled and uses suction monitor bellow that balances the wall suction and you can adjust the wall suction pressure by using a little rotary suction dial on the side of the system so this area right here this is where your suction monitor bellow is and it looks like a little orange accordion area and whenever you turn on the wall suction to this to this little orange accordion will start to expand out and you have this little triangle there that tells you once it gets to that triangle its regulating suction it's good and then here you have your suction control regulator and you have a little dial on the side where you can set the prescribed section of whatever the physician orders and here it's set on negative 20 like health it would be over there in the water suction now with the drive suction systems you can get a height you have higher suction pressure options there's no bubbling of water because you don't have a water column like how you do on wet section and there's no water evaporation with the wet suction because you have this water you have to fill it over time that this can evaporate so you'll have to monitor that make sure it's at a good level here you don't have that so you won't have water evaporation now let's look at our nursing interventions of things that you have to do for this patient who has a chest tube the biggest thing you want to do whenever you're taking care of a patient with a chest tube is you want to monitor the patient's respiratory status very closely you want to monitor the drain system itself and you want to know what to do when things go wrong like if the chest tube becomes dislodged accidentally or the system breaks and how to assist the physician with removing the chest tube and I'm going to be covering all those things so first let's talk about the drainage system and the tubing ok the drainage system itself needs to keep needs to be kept below the patient's chest and the tubing especially the tubing coming from the patient it tends to be long and bulky and patients roll over on it gets caught up in a side rail so you want to make sure that those connections are secured and that they're draining down into the system and that there's nothing no stagnant fluid collecting in those and clots and that your connections are still next while you are taking care of this patient with the chest tube you're going to be watching the collection chamber the water sealed chamber and the suction control chamber and this is going to tell you a lot about what's going on with the patient but first let's talk about the drainage collection chamber the drainage collection chamber is whenever you're monitoring this you want to note the color of the drainage how much they're putting out typically less than 100 CCS per hour and you want to record it very very well regularly because physicians are going to ask you how much is that chest tube putting out next the water seal chamber this is your water seal chamber on the dry section and on the wet wet section what does the water seal chamber do it performs an underwater seal to allow air to be removed from the floor space while preventing outside air from entering into the lungs because remember we want to create a negative pressure in there because that's what the lungs like so that water seal helps us do that now one thing you want to know this is normal the water will fluctuate in this water seal chamber it will auscultate up and down so that's normal you want that and whenever the patient breathes in if the water height will increase and when they expire have expiration decree the water will decrease however it's the opposite if the patient is on positive pressure mechanical ventilation whenever the vent breathes in for them the water will decrease when the vent breathes out for them the water will increase so just commit that to memory now NCLEX question what if the water in the water sealed chamber you notice it's not fluctuating at all what could be the issue well the lung may have re-expanded corrected or problem or there's a kink somewhere so you want to check that out next the air leak monitor area this is part of the water so chamber and at the bottom and what we're looking for and that is bubbling NCLEX loves ask questions about bubbling so what's the big thing normally there should be no bubbling in there because it's monitoring for air leaks however if you have excessive bubbling noted in that area that could mean an air leak however if the patient has a pneumothorax there could be intermittent bubbling in this now let's think back to a pneumothorax what is a new mouth works remember we talked about at the beginning of lecture where air enters in to the pleura space so as that air as that patient is recovering air will escape and leak from the lungs into the water sealed chamber so you could see a little bit of intermittent intermittent bubbling so that could be normal for them but the excessive continuous bubbling is not that can indicate an air leak okay next part of it is the suction control chamber remember on the wet section we have the water column and on the dry section we have the suction bellow a little regulator that works with that biggest thing you need to know is that with wet suction you're going to hear a continuous bubbling noise and you're going to see gentle bubbling and this that is normal because it's connected to wall section that's telling us it's working with and the water can evaporate over time so you want to make sure that you're adding water if it does evaporate evaporate to keep it at the prescribed amount of section with the dry section there's no water column and it's regulated by that section monitor bellow that little orange accordion thing other thing you want to do is you want to monitor your patients lung sounds how fast they're breathing if they're having any complaints of difficulty breathing like dyspnea and watch the insertion side look at it make sure it's free from infection and also check for any sub-q crepitus or sub-q emphysema also called that this is where carbon dioxide escapes into the tissues and whenever you feel it will be puffy and you feel it you'll never forget it if you ever feel it it feels like a crackling sensation underneath the skin also you're going to be having the patient cloth and deep breathe that helps move fluid and keeps their lungs nice and functioning and you're going to be repositioning them okay what to do if the chest tube becomes this Lodge this happens cover the site with a sterile dressing and tape it on three sides doing this will allow air to escape and prevent a tension pneumothorax and notify the position immediately okay what happens if this system breaks you walk into the room it's fell over cracked you need to get a new one while you're waiting on your new one to arrive order a new one you'll take the tubing and insert it one inch into sterile water to make that water seal and get a new system okay what about milking or stripping the tubing this used to be done a long time ago however it's not really recommended anymore and due to increasing pressure so always follow your hospital protocols with this another thing clamping another issue always follow Hospital protocols what do they say to do with that and because there's an increased risk of increase in the patient's chances of developing and tension pneumothorax and never do it without a physician's order okay so removal of a chest tube typically the physicians will do this and some facilities nurses have been checked off through competencies to do this but typically for NCLEX purposes you will be assisting the physician usually done at the bedside and what you will do is you will gather the supplies typically varies on physician preference so always make sure you know what your physicians like sterile gloves dressing supplies and this could be occlusive petroleum bass Tesla whatever a mask gloves a suture removal kit and rubber tipped hemostats okay one thing you're going to be doing prior prior to removal you're going to teach the patient how to do what's called the valsalva maneuver and this is where you have the patient take a deep breath exhale and bear down and they we'll do this during removal the reasoning for this is to prevent air from entering that pleural space during removal so that helps decrease that from happening then if ordered up you'll premedicate the patient for pain because this can be painful position the patient in semi fowlers position and afterwards you're going to monitor the respiratory status listen to those lungs sounds watch for equal chest rise and fall make sure it's not unequal any drainage is the patient breathing okay are they complaining it's hard to breathe and typically after a removal is done the physician will order a chest x-ray to assess lung expansion so that is an Inc let's review about chest tubes now going to my website register nurse orange comb and take the free quiz to test your knowledge and be sure to check out my other in CLECs review videos and thank you so much for watching and please consider subscribing to this YouTube channel

Channel: RegisteredNurseRN

Views: 1,656,789

Keywords: chest tube, chest tube drainage system nursing care, chest tube drainage system, chest tube drainage system nursing, chest tube management, chest tube air leak, chest insertion nursing, chest tube nclex, wet suction chest tube, dry suction chest tube, chest tube nursing, chest tube nursing care, chest tube drainage nursing care, chest tube assessment nursing, nclex chest tube, chest tubes, chest tubes nursing, chest tubes explained

Id: JB-CqwMyrTM

Length: 16min 17sec (977 seconds)

Published: Wed Aug 03 2016