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.

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.

This blog will teach you;

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.

4. Create- The nurse will integrate previous knowledge with knowledge gained from this course about chest tube care.

Begin by clinking the following link

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

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.

Reference

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.

Now watch a Prezi about Chest tube set up. Click on the following link

Chest tube setup

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

Chest Tube Drain Set Up Video

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

Troubleshooting Chest Tube 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

Now take this short quiz

Quiz

Reflection and knowledge sharing 

The last portion of this learning activity is the discussion post. This will help you to reflect on what you have learned and to discuss your thoughts, feelings, and knowledge with other students. Please respond to this discussion prompt in the discussion area

Now that you have learned about chest tubes and how to setup and manage one think about your fears and apprehensions about chest tubes. Did you have fears about chest tubes prior to this learning module about chest tubes? What fears did you have? How are these fears affected by this educational experience?

Many nurses express a fear about setting up and caring for a patient with a chest tube because it is not a skill used often and they do not feel competent. This is a high-risk time for the patient since this involves their respiratory system. It is important for nurses to recognize their fears and address them with knowledge and skills by becoming comfortable with the skills needed to care for a patient with a pneumothorax before and after chest tube insertion.
 Please follow this grading rubric for your discussion post. There is a total of 100 points, 25 for each criterion of the rubric. 

Criterion	25	22	19	17
1. Understanding-Nurses will explain the diagnosis and signs and symptoms that will lead to the need for a chest tube.	The Blog  discussion post is substantial in discussing the learning content within this learning Blog. Including 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.	The Blog  discussion post is basic in discussing the learning content within this learning Blog. Including 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.	The Blog  discussion post is simplistic in discussing the learning content within this learning Blog. Including 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.	The Blog  discussion post only includes one of the following  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.
2. Apply-The nurse will prepare for the procedure correctly	The Blog  discussion post is substantial in discussing the learning content within this learning Blog. Including 1. How to set up for a chest tube insertion 2. How to prepare the patient for the chest tube	The Blog  discussion post is basic in discussing the learning content within this learning Blog. Including 1. How to set up for a chest tube insertion 2. How to prepare the patient for the chest tube	The Blog  discussion post is simplistic in discussing the learning content within this learning Blog. Including 1. How to set up for a chest tube insertion 2. How to prepare the patient for the chest tube	The Blog  discussion post only includes one of the following Including 1. How to set up for a chest tube insertion 2. How to prepare the patient for the chest tube 2. How to prepare the patient for the chest tube
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.	The Blog  discussion post is substantial in discussing the learning content within this learning Blog. Including 1. The reasons a patient would need a chest tube. 1. How to assess and document the care of the patient while inserting a chest tube 2. How to assess proper functioning of the chest tube 3. How to troubleshoot problems with the chest tube	The Blog  discussion post is basic in discussing the learning content within this learning Blog. Including 1. The reasons a patient would need a chest tube. 1. How to assess and document the care of the patient while inserting a chest tube 2. How to assess proper functioning of the chest tube 3. How to troubleshoot problems with the chest tube	The Blog  discussion post is simplistic in discussing the learning content within this learning Blog. Including 1. The reasons a patient would need a chest tube. 1. How to assess and document the care of the patient while inserting a chest tube 2. How to assess proper functioning of the chest tube 3. How to troubleshoot problems with the chest tube	The Blog  discussion post only includes one of the following Including Including 1. The reasons a patient would need a chest tube. 1. How to assess and document the care of the patient while inserting a chest tube 2. How to assess proper functioning of the chest tube 3. How to troubleshoot problems with the chest tube
4. Create- The nurse will integrate previous knowledge with knowledge gained from this course about chest tube care.	The Blog  discussion post is substantial in discussing the learning content within this learning Blog. That includes refection on previous knowledge and experience	The Blog  discussion post is basic in discussing the learning content within this learning Blog. That includes refection on previous knowledge and experience	The Blog  discussion post is simplistic in discussing the learning content within this learning Blog. That includes refection on previous knowledge and experience	The Blog  discussion post only includes current knowledge gained