CHEST TUBE PREPARATION, INSERTION AND CARE
By Christie Winckler RN-BSN
Excelsior College
winckatme@gmail.com
Thank you for joining me in this learning opportunity!
Technology will be used in this learning module, if you should have any difficulties with any of the links please contact me via email above or comment in the comments to let me know of an issue.
Hello,
Welcome to an exciting adventure with Chest Tubes!
During this learning module you will learn about chest tubes. How to prepare for them and assist with insertion and care for them. This learning module will include various technology and you will be reading about chest tubes, watching videos, listening to instructions, testing your knowledge, reflecting on previous knowledge and incorporating it into new knowledge, and then discussing what you have learned. To complete this learning Blog, scroll down and watch the videos and select the links to each learning module.
Welcome to an exciting adventure with Chest Tubes!
During this learning module you will learn about chest tubes. How to prepare for them and assist with insertion and care for them. This learning module will include various technology and you will be reading about chest tubes, watching videos, listening to instructions, testing your knowledge, reflecting on previous knowledge and incorporating it into new knowledge, and then discussing what you have learned. To complete this learning Blog, scroll down and watch the videos and select the links to each learning module.
The activities provided in this learning module will guide you by using technology to learn about chest tubes and how to care for patients with chest tubes.
1. The reasons a patient would need a chest tube.
2. The signs and symptoms a patient would have if they needed a chest tube.
3. How to set up for a chest tube insertion
4. How to prepare the patient for the chest tube
5. How to assess and document the care of the patient while inserting a chest tube
6. How to assess proper functioning of the chest tube
7. How to troubleshoot problems with the chest tube
The learning outcomes for this learning Blog are;
1. 1. Understanding-Nurses will explain the diagnosis
and signs and symptoms that will lead to the need for a chest tube.
2. Apply-The nurse will prepare for the procedure correctly
3. Evaluate- The nurse will distinguish between a properly placed chest tube that is functioning correctly and one that is not based on patient signs and symptoms and the water seal chamber.
2. Apply-The nurse will prepare for the procedure correctly
3. Evaluate- The nurse will distinguish between a properly placed chest tube that is functioning correctly and one that is not based on patient signs and symptoms and the water seal chamber.
4. Create- The nurse will integrate previous knowledge with knowledge gained from this course about chest tube care.
Begin by clinking the following link
Nafady, H (2012). Tension Pneumothorax. Retrieved from 638.jpg?cb=1387522956https://image.slidesharecdn.com/pneumothorax-120908210906-phpapp01/95/pneumothorax-26-638.jpg?cb=1387522956
Transcript for Pneumothorax
Medical emergencies of the respiratory system require immediate
recognition and treatment to prevent death. One emergency involving the
respiratory system is a pneumothorax otherwise known as a collapsed lung. The
focus of this lesson will be on the signs and symptoms of a pneumothorax and
the treatment and management of a pneumothorax. The causes of pneumothorax
could be traumatic, spontaneous or environmental. (Pneumothorax, 2017).
Signs and symptoms of a pneumothorax may be vague or severe.
The symptoms depend on the severity of the pneumothorax. You see in this photo
that there are various sizes of a pneumothorax and this explains the various
signs and symptoms associated with a pneumothorax. As Air collects in the
pleural space the lung begins to shrink under the increased pressure from the
air surrounding the lung tissue.
A small
pneumothorax may have very vague symptoms of chest pain and may or may not be
associated with hypoxia or shortness of breath. A larger pneumothorax will
present with chest pain and shortness of breath and the patient will most
likely be hypoxic. A tension pneumothorax is the most severe and is caused by
the pressure outside of the lungs pushing the heart, trachea and vessels to the
opposite side of the chest. The patient will present with hypotension, hypoxia,
and a tracheal shift from midline. Another type of pneumothorax is a
hemo-pneumothorax where blood fills the chest cavity instead of air causing the
same symptoms but is caused by trauma.
Here you see a tension pneumothorax you’ll note at the red
arrows, that is the trachea that has shift and the heart is no longer on the
left side but has moved to the right side.
The definitive diagnosis is done by radiologic evaluation of
a chest x-ray.
In this photo you see an x-ray of a right-sided
pneumothorax.
Nafady, H (2012). Tension Pneumothorax. Retrieved from 638.jpg?cb=1387522956https://image.slidesharecdn.com/pneumothorax-120908210906-phpapp01/95/pneumothorax-26-638.jpg?cb=1387522956
Pneumothorax. (2017). Columbia Electronic Encyclopedia, 6th Edition, 1.
Pneumothorax. (2017). Columbia Electronic Encyclopedia, 6th Edition, 1.
Now watch a Prezi about Chest tube set up. Click on the following link
Acuclinic. (2017). Chest tube drain. Retrieved from http://www.acuclinic.com.au/pocit/ChestTubeDrain.jpg
Transcript for Chest tube set up
It is the responsibility of the RN to know what equipment is
needed for the insertion of a chest tube and how to set up for the procedure.
Let us start with the patient-
First, explain
the procedure to the patient. Tell them what the procedure is and what will be
happening throughout the procedure. Explain why the procedure is necessary and
what to expect during and after the procedure.
Next, you will
obtain consent from the patient for the procedure if the patient is alert and
stable enough to sign for consent. Otherwise, the consent may be signed by the
next of kin, health care proxy or guardian.
Apply oxygen to the patient if not already on the patient to
maintain Sa02 within the normal range
Apply the monitor to include cardiac monitoring, Sa02 monitoring,
and blood pressure monitoring
Next, you will position the patient. The patient will need
to have the arm on the affected side elevated out of the field. Someone way
hold the arm, or you can place it behind a pillow or secure the arm in this
position with tape. The patient may be sitting or supine. Then the patient
should be rotated slightly toward the opposite side
Have the
medication ready as MD orders medication for analgesia
The equipment you will need should be kept in one place
within the department to decrease set up time.
You will need a
bed-side table or Mayo stand to set up the equipment on
Select the
appropriate sized trocar according to MD order
Prepare the
thoracostomy tray- This is a sterile tray so do not open it until you are ready
and once open maintain the sterile field.
Set up the
chest drainage system- This is not a sterile object but comes in a sterile
prepared package _ more detailed information on the setup and assessment of the
drainage system will be explained later
You have to
have suction set up and ensure it is functioning properly by testing the unit
prior to using it. The suction tubing should be long enough to reach the
patient without pulling.
Sterile gloves and gown are needed for the MD performing the
procedure
You should have Betadine or Chlorhexidine to prepare the
insertion site
And have the medications needed for the procedure at the
bedside. You will need Lidocaine 1% and IV pain medication and or a sedative
type medication such as Versed.
A scalpel is needed if there is not one in the thoracostomy
tray
Suture should be 0 silk because this is a strong type of
suture
You will need Vaseline gauze for the dressing to ensure a
good seal around the tube insertion site
2-inch tape is
needed to secure the tube and dressing
4x4 gauze for the dressing
There are several different types of Chest drainage systems-
It is important to know what type your hospital uses and how to use them. They
all work in a similar fashion but are set up and monitored in different ways.
There are different brands and types.
Atrium is a brand of chest drainage system, and they have
different types of systems
The wet suctions system is called Ocean and looks like this
The dry suction system is called oasis and looks like this
And Plur-evac is another brand, and they have wet and dry
suction as well and here are a few different types.
As you can see they are all similar but have a few different
aspects to them.
Photos taken by Christie Winckler
Now watch this video on the set up of the chest tube drainage system
Atrium. (n.d.). 2002 Single Collection. Retrieved from http://www.atriummed.com/en/chest_drainage/images/2002-small.jpg
What happens when things go wrong? What can go wrong. Look at this Glogster to review what can go wrong with a chest tube system and how to assess for problems
Lau, C. A. (2009). Air leak monitor. Retrieved from http://hksccm.org/index.php/professional/useful-resources/70-respiratory-medicine-and-thoracic-surgery/476-2009-chest-drainage-system
Monitoring and care for a patient with a chest tube
Watch this PowToon about the care and maintenance of chest tubes
