CARE
Can you flush a pigtail catheter
Yes
How often do you document chest tube output?
q4H
What chamber do you look at to see if there is an air leak?
Chamber C
How do you find the policy on Chest Tubes?
PPGD- demo
How often do you change the chest tube dressing? For both large and small bore.
Large Bore: Q2days and PRN
Small Bore: weekly and PRN
How do you check for an air leak?
Air leaks are identified as bubbling in the water seal chamber. You assess by clamping the suction for 2 seconds and asking the patient to cough while looking at the water seal chamber.
What do you do if your chest tube gets knocked over
Assess drainage and replace atrium drainage system
Are we allowed to clamp chest tubes overnight?
No
What supplies should be in your patient's room?
Subcutaneous (under the skin) emphysema occurs when air gets into the tissues under the skin. What is this called?
crepitus
How do you change suction pressures?
Chamber A
Name 3 reasons your patient might have a chest tube
pleural effusion, pneumo, hemothorax
How long does the dressing stay on after the chest tube removal?
Mediastinal 24 hours post pull and pleural tubes 48 hours post pull
How much drainage do you want to report immediately to the LIP?
If patient has greater than 100cc/hr x 2 hours or greater than 500cc in 8 hours
What do you do if your patient's chest tube disconnects from the atrium?
place tube in small amount of sterile water. Call out for someone to get you a knew pleurvac, cleanse tube and connect to the new system. Notify LIP
What do you do if your patient's chest tube becomes dislodged?
Place vaseline gauze, DSD and medipore tape over the site. If unavailable place gloved hand over insertion site and call for dressing supplies, notify LIP
What size needle can you use to draw labs off a chest tube if sampling port is unsuccessful?
20g needle
You notice milky fluid in your chest tube what is the concern?
Chylothorax or thoracic duct leak and collection into pleural space. Chyle leak should be suspected post-op when there is milky fluid in the pleurvac and a triglyceride level >110. CT used to diagnose. Octreotide often used to treat but this might require surgery (thoracic duct ligation or embolization).
How do you change an atrium drainage system?
Demonstrate this one!
What are the dangers of clamping a chest tube?
+ pressure in pleural space and tube is clamped you can cause a tension pneumo. The pressure buildins up with no where to escape and causes the other lung to collapse as well. You can see a mediastinal shift which is an emergency & can lead to vfib.