Chest Tubes Nursing Care Management Assessment NCLEX Review Drainage System
Summary
TLDRIn this educational video, Sarah from registernurseRN.com provides a comprehensive review of chest tubes for nursing students preparing for the INLEX exam. She covers the anatomy, types of drainage systems, purposes, and nursing interventions for chest tube care. Sarah explains the function of chest tubes, the conditions they treat, and the differences between wet and dry suction systems. She also discusses nursing responsibilities, such as monitoring patients, handling complications, and assisting with chest tube removal.
Takeaways
- 😷 Chest tubes are inserted into the pleural space to remove air or fluid to help re-expand the lung.
- 🩺 Another type of chest tube is the mediastinal chest tube, which is placed under the sternum to drain fluid around the heart after cardiac surgery.
- 🌟 Pneumothorax, pleural effusion, hemothorax, empyema, and chylothorax are common reasons for chest tube placement.
- 💧 Wet suction and dry suction are two types of chest tube drainage systems, differing in how suction is regulated.
- 🔍 Nursing interventions include monitoring the patient's respiratory status, the drainage system, and knowing how to handle emergencies like dislodged tubes or system breaks.
- 📏 The drainage collection chamber should be monitored for color and amount of drainage, typically less than 100 cc's per hour.
- 🌊 The water seal chamber fluctuates with the patient's breathing, and its normal function is essential for maintaining negative pressure in the pleural space.
- 💨 Monitoring the air leak monitor area for bubbling can indicate an air leak or normal recovery from pneumothorax.
- 🚫 Clamping the chest tube is not recommended due to the risk of increasing tension pneumothorax, and should only be done with a physician's order.
- ✂️ Chest tube removal is typically done by physicians, and involves teaching the patient the Valsalva maneuver to prevent air from entering the pleural space.
Q & A
What is the primary purpose of a chest tube?
-The primary purpose of a chest tube is to remove air or fluid from the pleural space of the lungs to help re-expand the lung.
What is the role of the pleural space in the respiratory system?
-The pleural space allows the two layers of pleura to glide gently over each other during breathing, creating a negative pressure that enables the lungs to inflate and deflate properly.
What is a mediastinal chest tube and where is it typically placed?
-A mediastinal chest tube is a type of chest tube inserted into the mediastinum space, typically under the sternum, to drain fluid from around the heart after cardiac surgery.
What conditions can lead to the need for a chest tube?
-Conditions such as pneumothorax, pleural effusion (with different types like hemothorax, empyema, and chylothorax), and post-cardiac surgery complications can lead to the need for a chest tube.
What are the two basic types of chest tube drainage systems discussed in the script?
-The two basic types of chest tube drainage systems discussed are wet suction and dry suction.
How does wet suction in a chest tube system work?
-Wet suction is regulated by the height of the water in the suction control chamber. The water level determines the suction pressure, and bubbling in the system is normal as it indicates the suction is working.
How does dry suction differ from wet suction in a chest tube system?
-Dry suction does not use a water column. Instead, it uses a suction monitor bellows that balances with the wall suction, and it allows for higher suction pressure options without water evaporation.
What should a nurse monitor when caring for a patient with a chest tube?
-A nurse should monitor the patient's respiratory status, the drainage system itself, and be prepared to handle emergencies such as a dislodged chest tube or a broken system.
What is the significance of bubbling in the water seal chamber of a chest tube system?
-Bubbling in the water seal chamber can indicate an air leak. However, some intermittent bubbling can be normal, especially in patients recovering from a pneumothorax.
What is the Valsalva maneuver and why is it important during chest tube removal?
-The Valsalva maneuver involves taking a deep breath, exhaling, and bearing down. It is important during chest tube removal to prevent air from entering the pleural space, which could cause a tension pneumothorax.
What typically happens after a chest tube is removed?
-After a chest tube is removed, the physician may order a chest X-ray to assess lung expansion, and the nurse should monitor the patient's respiratory status and lung sounds.
Outlines
🩺 Introduction to Chest Tubes
Sarah from registernurseRN.com introduces a video lecture on chest tubes, focusing on the essential knowledge required for the inlex exam. She plans to cover the anatomy, different drainage systems, purposes, and nursing interventions for maintaining chest tubes. The lecture aims to educate on the insertion of chest tubes into the pleural space to remove air or fluid and help re-expand the lung. Sarah explains the negative pressure created by the pleural layers and how chest tubes are used to drain excess air or fluid that can cause lung collapse. She also discusses the mediastinal chest tube, used after cardiac surgery to drain fluid around the heart. The video will delve into various reasons for chest tube placement, including pneumothorax, pleural effusion, hemothorax, empyema, and chylothorax.
💧 Chest Tube Drainage Systems
The video script describes two types of chest tube drainage systems: wet suction and dry suction. The wet suction system uses a water column in the suction control chamber to regulate suction, with the height of the water determining the suction level. The dry suction system, on the other hand, uses a suction monitor bellows to control suction without a water column. Sarah explains how to set up each system and the differences in appearance and function. She also discusses nursing interventions, such as monitoring the patient's respiratory status, ensuring the drainage system is functioning correctly, and knowing how to respond if the chest tube becomes dislodged or the system breaks.
🌡 Monitoring Chest Tube Patients
The script details the nursing interventions for monitoring patients with chest tubes. It emphasizes the importance of keeping the drainage system below the patient's chest level and securing connections to prevent complications. Nurses must monitor the drainage collection chamber for color and amount of drainage, the water seal chamber for fluctuations indicating lung function, and the air leak monitor area for bubbling, which could indicate an air leak. The script also covers what to do if the chest tube becomes dislodged or the system breaks, including covering the site with a sterile dressing and notifying the physician. It mentions that milking or stripping the tubing is no longer recommended and that clamping should follow hospital protocols to prevent tension pneumothorax.
🩹 Removal of Chest Tubes
Sarah discusses the process of chest tube removal, typically performed by physicians with nursing assistance. She explains the steps prior to removal, including teaching the patient the Valsalva maneuver to prevent air from entering the pleural space during removal. The patient may be premedicated for pain, and the nurse should position them appropriately. After removal, the nurse monitors the patient's respiratory status, listens to lung sounds, and checks for equal chest rise and fall. A chest X-ray is often ordered post-removal to assess lung expansion. The video concludes with an invitation for viewers to take a free quiz on the website and to explore other inlex review videos.
Mindmap
Keywords
💡Chest Tube
💡Pleura
💡Pneumothorax
💡Pleural Effusion
💡Mediastinal Chest Tube
💡Wet Suction
💡Dry Suction
💡Air Leak
💡Nursing Interventions
💡Val Salva Maneuver
Highlights
Chest tubes are inserted into the pleural space of the lungs to remove air or fluid and help re-expand the lung.
The pleural space contains a small amount of serous fluid that allows the visceral and parietal pleura to glide gently over each other.
A pneumothorax occurs when air enters the pleural space and causes the lung to collapse.
A hemothorax is a type of pleural effusion where blood enters the pleural space due to trauma or disease.
Empyema refers to an infection in the pleural space, causing fluid buildup and lung collapse.
A chylothorax is a condition where lymphatic fluid enters the pleural space.
Mediastinal chest tubes are inserted into the mediastinum space to drain fluid around the heart after cardiac surgery.
Wet suction chest tube drainage systems use a water column to regulate suction.
Dry suction systems control suction with a suction monitor bellows and do not have a water column.
Nursing interventions for chest tubes include monitoring the patient's respiratory status and the drainage system.
The drainage collection chamber should be monitored for color, amount, and regularity of drainage.
The water seal chamber fluctuates with the patient's breathing, allowing air to be removed while preventing outside air from entering.
Bubbling in the air leak monitor area can indicate an air leak or be normal in cases of pneumothorax.
The suction control chamber in wet suction systems will show continuous bubbling, which is normal.
In dry suction systems, the suction is regulated by a suction monitor bellows, and there is no bubbling of water.
If a chest tube becomes dislodged, cover the site with a sterile dressing and notify the physician immediately.
Chest tube removal is typically done by physicians, and nurses assist by gathering supplies and preparing the patient.
After chest tube removal, a chest X-ray is usually ordered to assess lung expansion.
Transcripts
hey everyone it's Sarah with register
nurse rn.com and in this video I'm going
to be going over an inlex review about
chest tubes what I'm going to do in this
video is I'm going to cover the things
you need to know exactly for the inlex
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 aan.com 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 plal 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
plora and then we have this small little
space and then around that space that
attaches to our thoracic cavity is
called the paral plura and what happens
is that whenever you breathe in and out
these two layers Glide gently over each
other because in the pluris space
there's a small amount of Cirrus 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 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
causing this lung issues now there's
another type of chest tube which is um
called a media styal chest tube and this
is a tube that that is inserted into the
medianum space and it's typically placed
under the sternum to to drain fluid from
around the heart after cardiac surgery
because a lot of times after card
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 tampeno 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
pneuma thorax 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 they the doctor
wasn't sure why they had a numa thorax
it just happened
spontaneously another thing is called a
plora effusion and there's different
types of PL fusions depending on what
type of fluid is in that PL space and
what it is it's just fluid in the plor
space so here's your nice little space
and some fluid gets in there messes up
that pressure are setting and the lung
collapses and they have some major
breathing issues okay different types of
plor fusions you have hemothorax which
is where blood enters into the plor
space hemo means blood and this can be
due to trauma a a disease like
tuberculosis or a blood clotting issue
they're um not clotting so blood is
leaking in there another thing is called
epema where they can get an infection in
the plor space and last type of PL
Fusion is a silo thorax which is where
lymphatic fluid can get into the plora
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 um 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 in service on that because
different places have different chest
tube Drainage Systems okay here are your
basic ones I'm going to be going over um
for inlex purposes the wet suction and
the dry suction 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 and it's
draining down into the drainage chamber
these are your drainage chamber where
whatever is coming out of that lung is
Flowing down into there then in the
middle you have your water seill chamber
and there's blue water in this and as
the patient breathes in and breathes out
this water will TI will osculate up and
down and sometimes there's a little ball
in there that will move as well and then
you have a little mo an air leak monitor
area and in this area you were 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 Le 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 suction works so let's
cover it okay wet let's talk about the
wet section okay the wet section is
regulated by the height of the water in
the suction control chamber when it's
connected to wall suction so whenever
you're setting up a wet suction chest Tu
drainage you will be filling this with
the water that it comes with and
um depending on what the physician
orders you'll fill it up to whatever
they order um typically it's -20 cm 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 a suction monitor Bellow that
balances the wall suction and um 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 section to
this tube 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 it's
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 suction of whatever the
physician orders and here it's set on
-20 like how it would be over there in
the water suction now with the dry
suction systems you can get a high 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 suction and there's no water
evaporation with the wet suction because
you have this water you have to fill it
over time 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 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 okay 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
sealed next while you are taking care of
this patient with the chest tube you're
going to be be watching The Collection
chamber the water seal 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 cc's 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 suction
and on the wet wet section what does the
water seal chamber do it performs an
underwater seal to allow air to be
remove from the plor 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 still 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 osculate up
and down so that's normal you want that
and whenever the patient breathes in it
the water height will increase and when
they expire have expiration decrease 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 inlex question
what if the water in the water seal
chamber you notice it's not fluctuating
at all what could be the issue well the
lung may have re-expanded corrected our
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 SE chamber and it's at the bottom
and what we're looking for in that is
bubbling inlex loves ask questions about
bubbling so what's the big thing
normally there should be no bubbling in
there because it's monitoring for heirs
however if you have excessive bubbling
noted in that area that could mean an
air leak however if the patient has a
numo thorax and there could be
intermittent bubbling in this now let's
think back to to a pneumothorax what is
a pneumothorax remember we talked about
at the beginning of the lecture it's
where air enters in to the plora space
so as that air as that patient is
recovering air will escape and leak from
the lungs into the water seal chamber so
you could see a little bit 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 um little
regulator that works with that biggest
thing you need to know is that um with
wet suction you're going to hear a
continuous bubbling noise and you're
going to see gentle bubbling in this
that is normal because it's connected to
wall section and 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 suction with the dry suction
there's no water column and it's
regulated by that suction monitor Bellow
that little orange accordion thing other
thing you want to do is you want to
monitor your patient's lung sounds how
fast they're breathing if they're having
any complaints of difficulty breathing
like dmia um watch the insertion side
look at it make sure it's free from
infection and also check for any subq
crepus or subq osine also called that
this is where carbon dioxide escapes
into the tissues and whenever you feel
it'll 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 and also you're
going to be having the patient cough 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 dis loded if 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 Numa thorax and notify the
physician immediately okay what happens
if the 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
um 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 um due to
increasing pressure so always follow
your hospital protocols with this
another thing clamping another issue
always follow your hospital protocols
what do they say to do with that um
because there's an increased risk of
increasing the patient's chances of
developing tension numo thorax and never
do it without a physician's order okay
so removal of a chest tube typically the
Physicians will do this in some
facilities nurses have been checked off
through competencies to do this but
typically for inlex purposes you will be
assisting The Physician usually done at
the bedside and what you will do is you
will gather the supplies uh typically
varies on physician preference so always
make sure you know what your Physicians
like uh sterile gloves dressing supplies
um this could be a clusive petroleum
base tefla 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 Val Salva maneuver and
this is where you will have the patient
take a deep breath exhale and bear down
and they will do this during removal the
reasoning for this is to prevent air
from entering that plural space during
removal so that helps decrease that from
happening then if ordered uh you'll
premedicate the patient for pain because
this can be painful uh position the
patient in semi fowers position and
afterwards you're going to monitor the
respiratory status listen to those lung
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 inlex review about chest tubes now
go to my website register nurse rn.com
and take the free quiz to test your
knowledge and be sure to check out my
other inlex review videos and thank you
so much for watching and please consider
subscribing to this YouTube channel
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