Chest tube assessment and care

 

Complications resulting in the need for a chest tube:

  1. Pleural effusion
  2. Hemothorax
  3. Empyema (pus)
  • Symptoms:

 

  1. Dyspnea
  2. Cough
  3. Chest Pain
  4. Fever
  5. Malaise

 

Mediastinal Chest tube purpose:

  • removal of blood or fluid from around the heart

 

Documentation:

  1. Volume of drainage (date and time)
  2. Suction Rate
  3. Nature of drainage (measure and character)
  4. mark on pneumothorax container then replace when full

 

Drainage System Troubleshooting:

  • No tidling indicates the system is not patent or that lungs have expanded to normal
  • Intermittent bubbling is normal, if continuous bubbling occurs the tube has been displaced
  • rapid bubbling may indicate air leak around incision or tear in pulmonary pleura

 

Assessments:

  1. Patient
  2. Site
  3. Tubing
  4. Timing = q15min for first hr after insertion, then q4h

 

Patient Assessment:

  1. vital signs
  2. oxygen saturation
  3. level of orientation
  4. respiratory assessment
  • signs and symptoms of increased respiratory distress:
  • displaced trachea
  • decreased breath sounds over both affected and unaffected sides
  • marked cyanosis
  • asymmetrical chest movements
  • chest pain:
  • sharp, stabbing chest pain – indicative of tension pneumothorax
  • pain on inspiration – indicative of hemothorax or pneumothorax
  • hypotension
  • tachycardia
  • pain scale
  1. Hg and Hct

 

Site assessment:

  1. Chest tube Dressing and surrounding insertion site -norm = Dry and Intact
  2. Drainage
  3. Subcutaneous emphysema
  4. Sudden increase in drainage of more than 70ml may indicate new thoracic bleeding

 

Tubing assessment:

  • tight system connections
  • appropriately taped
  • tubing not kinked, or obstructed
  • prevent dependent loops
  • avoid milking or stripping the drainage in tubing

 

Drainage Unit Chambers:

  • Set upright
  • insure drainage collector is below the level of the patient`s chest
  • ensure tidling is occurring with patient inspirations and expiration
  • lung re-expansion may have occurred if no tidling occurs and 2-3 days have passed
  • An air leak may be indicated by fluid bubbling left to right when facing system.
  • assess the suction level is as per doctors orders
  • sudden halt in drainage may indicate clot or other blockage in the drainage system
  • Know expected drainage colour when assessing

 

Clamp tubing (but only for seconds) when:

  • locating leaks
  • replacing the system
  • as per physicians orders to trial if pneumothorax has resolved
  • 2 non-toothed clamps should be at the patient`s bedside at all times
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