CARE
Can you flush a pigtail catheter?
Q4H
Chamber C
How do you find the policy on chest tubes?
PPGD (Demonstrate)
How often do you change the chest tube dressing?
Large Bore: q2d and PRN
Small Bore: Weekly and PRN
How do you check for an air leak?
Air leaks can be identified as bubbling in the water seal chamber. You assess for an air leak by clamping the suction for briefly and asking the patient to cough while you look at the water seal chamber.
What do you do if your chest tube gets knocked over?
Replace atrium drainage system
Are we allowed to clamp chest tubes overnight?
No
What supplies should be in the patient room?
Kelly Clamp, Vaseline Gauze, Sterile 4x4 gauze, Tegaderm, and bottle of sterile water
subcutaneous emphysema occurs when air gets into tissues under the skin. What is this called?
Crepitus
How do you change suction pressures?
Chamber A (Demonstrate)
Name 3 reasons a patient might have a chest tube?
Pleural effusion, pneumothorax, hemothorax
How long does the dressing stay on after chest tube removal?
Mediastinal 24 hr
Pleural 48 hr
How much drainage do you want to report immediately to the LIP?
Notify the LIP if patient has greater than 100 CC x2 hours of 500 in an 8 hour period.
What do you do if your patient's chest tube disconnects from the atrium drainage system?
Place tube in small amount of sterile water if not available place in cup of water. Call out for someone to bring you a new pleuravac, cleanse tube, and connect to a new system. Notify the APP immediately.
What do you do if your patient's chest tube becomes dislodged?
Place vaseline gauze, dsd gauze and medipore tape over insertion site. *Bonus what do you do if dressing supplies are not in the room?
20g
You notice milky fluid in your chest tube, what is your concern?
Chylothorax is the term used for thoracic duct leak and collection into the pleural space. Chyle leak should be suspected in the post-surgical period when there is a serosanguinous fluid or milky fluid in the drain, a triglyceride level >110 mg/dL in the fluid, and a CT scan is useful in diagnosing. Drainage of the fluid in symptomatic patients along with dietary control measures and concomitantly treating the underlying cause is the goal. Ocreotide is often used to reduce the number of leaks and to avoid surgery. Many end up needing an intervention such as thoracic duct ligation or embolization.
How do you change an atrium drainage system?
demonstrate
What are the dangers of clamping a chest tube?
If you have + pressure in the pleural space (which normally is a negative pressure space) and the chest tube is clamped, you can cause a tension PTX. The pressure builds up and now does not have anywhere to escape and causes the other lung to collapse as well. You will see a mediastinal shift which is an emergency and can lead to V-FIB