Chest Tubes Nursing Care Management Assessment NCLEX Review Drainage System

Summary

In 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

00:00

🩺 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.

05:01

💧 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.

10:04

🌡 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.

15:05

🩹 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.

Keywords

💡Chest Tube

A chest tube is a medical device inserted into the pleural space of the lungs to remove air or fluid, helping to re-expand the lung. In the video, chest tubes are discussed as a critical intervention for various conditions that affect lung function, such as a pneumothorax or pleural effusion. They are essential for maintaining proper negative pressure within the pleural space, which allows the lungs to inflate and deflate properly.

💡Pleura

The pleura refers to the protective layers surrounding the lungs, consisting of the visceral pleura attached to the lung and the parietal pleura lining the thoracic cavity. These layers are crucial for the gliding motion that occurs during breathing, which is facilitated by a small amount of serous fluid between them. The script mentions the pleura in the context of explaining how chest tubes help restore normal pleural space dynamics when disrupted by conditions like pneumothorax.

💡Pneumothorax

A pneumothorax is a condition where air enters the pleural space, causing the lung to collapse. The video script describes it as a potential reason for chest tube insertion, where the tube helps to remove the air and allow the lung to re-expand. It can occur due to trauma or spontaneously, as mentioned in the script with examples of patients admitted with spontaneous pneumothorax.

💡Pleural Effusion

Pleural effusion refers to the abnormal accumulation of fluid in the pleural space. The script explains different types of effusions, such as hemothorax (blood), empyema (pus), and chylothorax (lymphatic fluid), each affecting lung function by altering the pleural space pressure. Chest tubes are used to drain this fluid and alleviate breathing difficulties.

💡Mediastinal Chest Tube

A mediastinal chest tube is a specific type of chest tube inserted into the mediastinum space, typically under the sternum, to drain fluid around the heart after cardiac surgery. The video mentions that these tubes are placed to prevent cardiac tamponade, a life-threatening condition where fluid compresses the heart, impairing its function.

💡Wet Suction

Wet suction is a type of chest tube drainage system where the suction is regulated by the height of the water in the suction control chamber. The script describes how the water level dictates the suction strength, with bubbling in the chamber indicating proper function. It contrasts with dry suction, where there is no water column involved.

💡Dry Suction

Dry suction is another chest tube drainage system where suction is controlled using a suction monitor bellows that balances wall suction. Unlike wet suction, there is no water column, and the script notes that this system allows for higher suction pressure options and does not have water evaporation issues.

💡Air Leak

An air leak is a complication where air escapes from the lungs into the pleural space. The video script discusses monitoring for air leaks by observing bubbling in the water seal chamber of the chest tube system. Continuous bubbling, as opposed to the normal intermittent bubbling seen in certain conditions like pneumothorax, can indicate an air leak.

💡Nursing Interventions

Nursing interventions encompass the care actions taken by nurses to maintain patient health, including monitoring, assessment, and direct care related to chest tubes. The script outlines specific interventions such as monitoring the drainage system, observing for signs of complications, and assisting with chest tube removal, all crucial for patient safety and recovery.

💡Val Salva Maneuver

The Val Salva maneuver is a technique taught to patients before chest tube removal, where they take a deep breath, exhale, and bear down. This is mentioned in the script as a method to prevent air from entering the pleural space during tube removal, thus reducing the risk of developing a tension pneumothorax.

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

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