Mediastinal Drainage
Chest tubes placed after coronary artery bypass surgery are positioned in this sac
What is pericardial?
This condition is characterized by an accumulation of air between the visceral and parietal pleurae
What is a pneumothorax?
Seeing these in the water seal chamber indicates an air leak in the chest drainage systems
What is bubbles ?
What is the time interval for routinely changing a chest tube dressing
What is soiled, loose or otherwise compromised"
This is the first thing that should be done if a transfusion reaction is suspected
What is stop the transfusion and hang a new bag of normal saline with new tubing, in order to flush the IV
This complication is characterized by muffled heart tones, decreased cardiac output and increased right atrial pressure
What is pericardial/ cardiac tamponade?
This condition is characterized by diminished or absent breath sounds on the affected side, a shift of the trachea away from the affected side and hyperresonance to percussion
What is a tension pneumothorax?
This is the name for the up and down motion of the water in the seal chamber that corresponds to the intrathoracic pressure changes associated with a patient's respirations
What is tidalling ?
A patient with a chest tube is scheduled to go to the radiology department for chest radiograph. What would you do with the drain and the tubing when the patient is on the stretcher, ready for transport
Disconnect from suction, if stopcock is present on suction tubing, check to see that the stopcock is in the completely open position; assure that the drain remains below the patient's chest level to allow for gravity drainage; check to see that there are no dependent loops (do not clamp during transport)
These two transfusion reactions both initially present with shortness of breath and dyspnea.
What is TACO & TRALI
This action can create negative pressures as high as -400 cm H2O in the chest and is no longer recommended for routine postoperative nursing care of of patients with mediastinal chest tubes
What is stripping the tubing ?
Using anatomical directional terms, describe the position a chest tube is ideally located in when placed in the chest to drain fluid alone
What is inferior and posterior?
When a patient takes in a very deep breath before a cough, and creates high negative intrathoracic pressure, what will happen to the water level in the water seal chamber
What is it will rise?
Describe how the wall vacuum regulator should be adjusted for a patient with routine chest drainage with a water filled suction control chamber
Turn suction regulator down until bubbling just stops. Then increase the wall vacuum source until gentle bubbling just begins in the suction control chamber
This is the role of the RN in the consent process
What is witness consent
This type of coronary artery bypass surgery grafting may require a pleural chest tube postoperatively if the pleural space is entered
What is left internal mammary artery graft (LIMA)?
Using anatomical directional terms, describe the position a chest tube is ideally located in when placed in the chest to evacuate air alone
What is anterior and superior?
Describe what the numbers on the long arm of the water seal chamber mean
The water seal chamber is a U-tube manometer. The numbers are measurements of negative pressure in cm H2O?
There has been no evidence of an air leak in the water chamber, the lung is fully re-expanded on a chest radiograph ad fluid drainage has been less than 50 mL in the past 24 hours. What procedure can you expect to prepare the patient for?
What is chest tube removal?
Blood products are verified here
What is at the bedside
This substance, covalently bonded to some chest tubes, decreases the incidence of catheter thrombosis
What is heparin?
This amount of fluid (mL) is required for a pleural effusion to be seen on an upright chest radiograph
What is 300 to 500 mL?
If the level of water in the water seal chamber is halfway up the long arm of the chamber, the nurse should perform this action to return the water back down tot eh baseline level in the chamber after the patient's condition has been assessed
What is depress the manual high negativity vent on the top of the chest drain ?
A mechanically ventilator patient's chest tube has become disconnected from the tubing leading to the drain, and the drain is cracked. Prior to this event, there was bubbling in the water seal chamber. While a colleague is getting another drain, what immediate nursing action would be best for this patient
Stick the end of chest tube into a bottle of sterile water or sterile saline to a depth of approximately 2 cm
This transfusion reaction initially presenting with shortness of breath and dyspnea, along with hypotension and fever, can improves with fluids
What is TRALI