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Chest Tubes

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by

Kristina Kochman

on 23 August 2014

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Transcript of Chest Tubes

Troubleshooting
Chest Tubes

Disconnect from drainage system or system breakage
Clamping
Subcutaneous Emphysema
Audible Air Leak
Sounds different than previous assessments
If at insertion site, call physician
If along tubing, replace if possible (change device), or call physician for further instructions
Can use clamps to isolate leak
Chest tubes should not be clamped during patient movement, trips off unit, etc.
Clamping blocks drainage, which could result in a tension pneumothorax or cardiac tamponade
Indicates air escaping from the pleural space and into the tissue
Take down dressing and carefully inspect the site where tube leaves the chest wall to look for any evidence of drainage "eyelets" that may have pulled out
Tube movement can allow air to enter the subcutaneous tissue, even if eyelets are not visible.
Re-dress site and call MD
Immediately submerge distal end of the tube in 1 inch of sterile water or NaCl in sterile container
Creates a water seal until you can prepare and attach new system
If tubing becomes disconnected, clean the connectors with alcohol and reconnect
Kristina Banks, MSN, ARNP, FNP-C
Advanced Education Specialist
Johns Hopkins All Children's Hospital
Only clamp chest tubes to:
Locate an air leak
Simulate removal (assess tolerance)
Replace a drain
Dislodged or Accidental Removal
Immediately cover site with Vaseline gauze and a dry sterile dressing, only taping 2 or 3 sides
If patient is old enough and can follow instructions, have them perform Valsalva maneuver or exhale forcibly before covering
Call MD
Tension
Pneumothorax
May develop with obstructions in system
Kinked/clamped tubing
Signs/Symptoms:
Diminished breath sounds
Increased RR & HR
Tracheal deviation (late sign)
Kinked Tube
Follow from patient to drainage device to look for kink
If resolvable, fix kink and monitor patient. If unresolvable, call MD immediately
Signs/Symptoms: Increased WOB, diminished breath sounds, change in amount of drainage
Acronyms
F
luctuation (Tidaling)
O
utput (Amount, Consistency)
C
olor of Drainage
A
ir Leak
Measure 1-5 in water seal chamber
New or worse air leak?
Check dressing, connections
D
islodgement
O
bstruction
P
atient problem
E
quipment problem
Full transcript