The Setup
This is the suction strength that is most commonly ordered.
What is -20cm H2O?
When transporting a patient, this is required if they are currently on wall suction
What is a physician's order to disconnect from wall suction?
Or what is a pneumostat?
Uh oh! The chest tube just became disconnected! These would be your initial steps
What is:
- Clamp tube
- Use aseptic technique to clean with chlorhexidine and reconnect to a new drainage system ASAP?
To improve accuracy of saturation readings in a cardiac patient, you may choose to use this piece of equipment.
What is a BLUE sat probe?
This congenital cardiac defect would clinically show pre-sats LOWER than post-sats and can have acute deterioration around 24 hours of age
What is TGA?
This is how much fluid should you add to the system on setup.
What is 20mLs H2O - the contents of the syringe that comes with the drainage system.
This is an essential part of the safety kit to keep available at the bedside.
What are blue non-toothed clamp forceps?
This is the reason chest tube stripping should be avoided.
What is that it creates high negative pressure and can cause pain, tissue trauma, and bleeding?
This is the best way to determine whether the source of an air leak is coming from the patient or the drainage system
What is clamp near the patient?
If it stops, the leak is likely at the insertion site. If it continues, check connections and drainage system
Name the four primary defects that makes up Tetralogy of Fallot
What are:
-Overriding aorta
-Pulmonary stenosis
- VSD
- RV Hypertrophy
This is the best way to know if the wall suction is providing enough pressure.
What is check the orange floater in the window?
Name three key assessments that should be documented on a patient with a chest tube?
What are:
- Drainage amount/colour
- Presence of an air leak
- Integrity of chest tube dressing
-Site condition (Redness, drainage, subcutaneous emphysema)
These are the only acceptable reasons to clamp a chest tube
What are changing the system, taking a sample, troubleshooting an air leak, or with a physician's order
This indicator lets you know whether the wall suction is working appropriately
What is the orange float in the suction control indicator window?
What two primary strategies can you employ to increase SVR and decrease PVR in a Tet Spell?
What are calm patient - give morphine, and place knees to chest.
This is a clear sign there is an air leak.
What is rapid bubbling in the air leak chamber
How often should a chest tube dressing be changed?
What is when soiled or wet or no longer intact and PRN?
Note: please notify MD if dressing needs to be changed but change can be done by RN using aseptic technique.
What is vent excessive negative pressure in the drainage system?
With a sudden decrease in chest tube drainage, these are the first three things you should check.
What are:
- Assess for kinks
- Ensure tube has not migrated
- Ensure no blockage in tube
(and be sure to notify physician!)
What maternal autoimmune disease makes infants more susceptible to congenital heart block?
What is maternal lupus?
These are the only acceptable ways to store the drainage system
What is taped to the floor or hanging both sides from a low rung?
Use these two strategies can you use to ensure the chest tube does not become displaced.
What are a grip-lok and pin a taped flag to the bed sheet? (be sure to undo when moving patient!)
Uh oh, the chest tube is accidentally dislodged! what is the immediate nursing response?
What is cover the site with muko, gauze, and tegaderm?
This is the primary purpose for the air leak indicator
What is to determine whether a pneumothorax (air leak) is draining from the chest cavity?
What supportive measures might you ask the team to order if a cardiac patient is having difficulty with fluid overload?
-NG feeds
-Increased calories/decreased volume (restrict TFI)
- Diuretics (lasix, aldactazide)
- Low flow O2 or NCPAP