Chest Tubes - Nursing Management & Assessment NCLEX RN & LPN

[Applause] [Music] now for chest tubes as you know chest tubes are used to drain fluid blood or air from the pleural space within the lung in order to re-expand a collapsed lung and so the main purpose is to restore a normal negative pressure within the pleural space like with a pleural effusion where we have fluid in the pleural lung space or a hemothorax that blood in that pleural lung space and even pneumothorax that air inside that lung space now how does a chest tube work well by inserting the tube into this pleural lung space it simply sucks out that air fluid or blood into a closed one-way drainage system so naturally we must keep the drainage system below the chest level to help with drainage so hesi mentions this asking interventions for a client with a chest tube for a pneumothorax and the answer is to keep the drainage below the chest level yes gravity helps with drainage now for chest tube care the three chambers to know for your nursing exams and the nclex is number one the suction control chamber right here number two the water seal chamber that also has an air leak gauge right here and third the collection chamber to measure output so starting with number one the suction control chamber key terms here write this down we want to see gentle steady or key terms continuous bubbling this means we have a good amount of suction being applied especially with clients with a pneumothorax that air inside the lung again gentle continuous bubbling means the chest tube is working not vigorous or violent bubbling this means that the suction is too high so the memory trick we use just think of a child sucking down a milkshake in the suction control chamber we want gentle continuous bubbling not vigorous or violent bubbling just like the milkshake vigorous bubbling is not good and could get a little bit messy next we have the water seal chamber and air leak monitor this guy acts as a one-way valve to help drain air and fluid from the lung and also prevents air from entering that chest cavity now it's good to see a steady rise and fall with breathing this is known as tidaling and this is good it means that the system is working correctly and keeping that negative pressure naturally rising and falling with each breath and this will naturally reduce as the lung re-expands now continuous bubbling is very bad typically it means that there's an air leak inside the system oh no but we'll cover this more in detail in a moment so the memory trick just think of a seal inside the ocean for the water seal this seal floats up and down with the tides of the waves nice and even every time it takes a breath so this is titling that rise and fall with the tide now a big no-no is we never want this seal to be blowing continuous bubbles under the water so just think of a lifeguard saying hey no bubbling in the water you seal check out our brand new app and get access to our new pharmacology and med surg mastery courses plus 11 other courses like fundamentals pediatrics maternity mental health and more complete with over 300 follow along cheat sheets and a massive quiz bank loaded with detailed rationales to test your knowledge join for free click the link in our description below so that's how i remember no continuous bubbling in the air leak chamber of the water seal now kaplan mentions what is the best response by the nurse when a client is asking about titling in the water sealed chamber the answer is it shows your lung has not yet re-expanded and ati mentions possible indication of lung re-expansion well titling in the water seal chamber has stopped yes this could mean lung re-expansion so if we no longer see this titling those fluctuations up and down again it could mean two things either the lung has fully re-expanded as ati stated here which is good news and we can remove the tube or the bad news we don't want this it could indicate that a blockage like a blood clot is stuck in the tube or maybe there's a kink somewhere inside the tube so kaplan mentions monitor for fluctuation in the water seal no fluctuation may indicate a blockage so write down these key words they use fluctuation instead of titling basically the same thing so no fluctuation may indicate that blockage next we have the air leak monitor found right here near the water seal chamber now the nclex loves to ask about the location of this air leak gauge so write down and know this location now what do you think the air leak monitor does well hmm do you think it might monitor some air leaks well yes so the key point to write down is not that the key point here once again is continuous bubbling is bad this key term means we have an air leak and air leaks are not good here there should be no continuous bubbling in the air leak chamber or the water seal so just think it should not look like a hot tub in there no hot tubs and no time machines now intermittent bubbling that comes and goes is perfectly normal that typically happens when you sneeze or if the client coughs now third the collection chamber this helps to drain the fluid as well as the blood from the lung we assess this chamber every hour for the first eight hours from insertion then every eight hours after that now the key numbers to know of when to notify the hcp write this down it's always on exams bright red blood over 100 ml per hour after the first hour of placement now the key term here that you have to focus on is bright red blood worry about the bright red since this means active hemorrhage so just think if the blood is bright then something ain't right we must notify the provider especially after surgery or new insertion within the first eight hours now don't let the nclex trick you here we do not clamp the chest tube this will only back up heavy drainage and make pressure in the lung cavity worse and if we see bright red blood we do not give pain meds as the first intervention this obviously won't stop the bleeding so we must notify the provider first with that bright red okay now switching gears what happens if the blood is dark red again don't let the nclex trick you here just think d for dark bloody drainage is normal so we d document and monitor since it's old blood say you're turning the patient two to three days after surgery and suddenly about 200 ml of dark blood drains in the collection chamber like all of a sudden what do you do do you freak out and call your own mama well no it's not bright red blood it's dark blood so we know that it's old blood so again just think of the double d's here it's dark blood so we just document and don't be alarmed with the amount of this dark bloody drainage since it's a few days after surgery so remember timing and color are everything with these drainage questions again our memory trick just think dark blood we document since the blood is old and it's probably been there for a few days and with bright blood well that ain't right blood so especially within the first few hours of placement it's new and fresh we must notify the hcp that provider okay now what do we do for stopped or decreased drainage say the patient has consistent output for the entire shift and then all of a sudden a few hours ago the drainage stops well question for you here do we assess the patient first or the chest tube first hmm well always assess the patient first and machine second that's always on the nclex and exams so write it down we assess the patient first by listening or auscultating lung sounds now we do not want to hear diminished breath sounds because that is a priority this indicates that the chest tube is not working to improve that airflow and typically means that the patient is now filling up with blood or fluid very deadly so write it down diminish breath sounds are priority second we turn cough and deep breathe and third we reposition the patient since blood or fluid can collect in one area of that lung space and if the patient's been laying down in a certain position for too long blood or fluid can collect there as well now kaplan had a question about this asking about priority for a client with three chambered chest drainage system for hemothorax and the answer is to assess the client's respiratory status frequently remember we assess the patient first and then devices later so don't let the nclex trick you here we do not adjust the suction technically we need an order for that and don't assess the chest tube initially a lot of students get this wrong on their nclex and exams so write it down and know it we always assess the patient first before machines now as far as general patient assessment we do rounds every two hours we always listen to breath sounds and check the drainage around the chest tube to see if any blood or pus from infection is there now a big one here is subcutaneous emphysema that trapped air under the skin sort of feels like rice krispies underneath the skin snap crackle and pop now this is normal and to be expected on insertion but here's the key it should not be growing in diameter typically we mark the patient with a marker to make sure this crepitus is not spreading okay now for the complications that you will be tested on so write these down it's the two ds disconnection and damage to the chest tube so what happens when the chest tube itself gets disconnected cracked kicked or even body slammed body slammed uh well yeah anything can happen so starting with disconnection from the patient this typically happens by accident so we must tell the patient to cough and exhale immediately to prevent air from rushing into that pleural space causing that deadly tension pneumothorax and collapse in the lung we basically have a hole in the chest here right in essence we've created a sucking chest wound so hesi mentions interventions for a client with a chest tube for pneumothorax if the tube becomes dislodged ask the patient to cough and exhale as much as possible yes this prevents air from rushing into that pleural space and then immediately we do number two which is apply occlusive petroleum gauze dressing and secure on three sides not four sides but three sides now don't let the nclex trick you here three sides only this allows air to escape upon exhalation basically when we breathe out so the memory trick only take three to let the air free a lot of students get this wrong and choose to tape four sides which does not allow air out so pressure can build up inside the chest causing that deadly tension pneumothorax basically so much air pressure that it can push all the organs to one side even the trachea that windpipe and eventually collapse the good lung now kaplan mentions essential equipment to have at the bedside of a client with closed chest drainage system we have to have a sterile connector sterile petroleum gauze this is our occlusive dressing as mentioned in other question banks as well as padded clamp so write that down sterile petroleum gauze or occlusive dressing now if the chest tube gets disconnected from the collection chamber itself well we have two options for disconnection or damage to the drainage tube if it's without contamination then we use an aseptic swab and just simply reconnect it now if there's damage to the water seal itself resulting in draining all the water out of the seal then we must place the distal end into sterile saline or sterile water so once again write down the keywords if the water seal chest tube is damaged we place the distal end into sterile saline and a little side note here we never clamp the chest tube this is only done a few hours before the removal or changing the drainage device clamping a chest tube prematurely can cause a deadly tension pneumothorax which again can push all the organs and windpipe to one side now speaking of chest tube removal it's critical to tell the patient these key words take a deep breath hold it and bear down that they'll self a maneuver this is done while the tube is being removed so write that down this prevents air from being sucked back into the pleural space causing that pneumothorax air inside the lung space again we must take a deep breath hold it and bear down bear down not a slight inhalation but a big one then we typically take a chest x-ray afterward just to make sure there's no new air or fluid inside the lung space now for the big no-nos we have three here number one we never milk or strip a chest tube this could create more pressure within the patient causing that deadly tension pneumothorax so just think stripping can be dangerous i was this close to stripping but never mind just remember never strip or milk a chest tube now the second thing is we never want to see continuous bubbling in the key term water seal or air leak chamber the only place that should have continuous bubbling should be the suction chamber like we're sucking bubbles again think of that seal here remember by saying no blowing bubbles you seal and lastly number three never clamp during transport now we talked about this before as a general rule on the nclex and exams we never clamp a chest tube technically clamping is only done a few hours before chest tube removal or when we're changing that drainage device because clamping a chest tube thanks for watching for our full video and new quiz bank click right up here to access your free trial and please consider subscribing to our youtube channel last but not least a big thanks to our team of experts helping us make these great videos all right guys see you next time you

Channel: Simple Nursing

Views: 286,622

Keywords: Chest tubes, Chest tube, Airleak chamber, Chest Tube management, Chest tube drainage, Chest tube care, Chest tube interventions, NCLEX chest tubes, Chest tubes nursing RN

Id: WfoXkJM6XHw

Length: 16min 51sec (1011 seconds)

Published: Tue May 25 2021