Chest Tubes
List 2 things that should be done when setting up a chest tube.
Check that it’s set to -20cm H20/ what the order is prescribed to.
Fill the water seal chamber to the 2cm water line.
Set wall suction to at least 80 and watch for the orange bellows to move to the green indicator- letting you know the suction is working when the tubing is connected.
Set up the kick stand to support the Chest tube device.
How often are all vital signs checked during moderate sedation?
Every 5 minutes
What is the purpose of placing a fiducial marker during Dr. Moore’s procedures?
To help precisely guide future radiation therapy or surgery.
Who can administer medications in IR?
RNs, PAs, APRNs, Physicians, Anesthesia- techs can administer contrast if they have completed NYS training and only under supervision of a provider.
What is the primary purpose of the IR pre‑procedure intake call?
To confirm key instructions (NPO, medications, escort needs), review medical history/allergies, and ensure the patient is safely prepared for their procedure.
What position should a chest tube always remain in to prevent backflow?
Below the level of the patients chest.
Name 4 things you must monitor continuously during procedural sedation in IR?
Required monitoring includes:
continuous cardiac monitoring (telemetry)
continuous pulse oximetry
blood pressure at minimum every 5 minutes
respiratory rate
end-tidal CO2/capnography where available
and level of consciousness/sedation scale score.
What is the most common positioning for Dr Moores lung biopsies and ablations?
Prone.
Which tool assesses level of sedation?
The RASS score.
Who is the only person permitted to perform site marking?
The attending proceduralist.
What does tidaling in the water seal chamber indicate, and in which direction should fluid move during inspiration with a spontaneously breathing patient?
Tidaling indicates the chest tube is patent and the system is functioning. In a spontaneously breathing patient, fluid rises on inspiration and falls on exhalation.
**In a mechanically ventilated patient, this is reversed.
Before starting procedural sedation, what must the nurse confirm is in place at the bedside- list 5?
Working IV
oxygen
suction
bvm
telemetry
reversal agents
Which CT‑guided chest procedures involve treatment rather than diagnosis?
Ablations.
What MUST be on every medication label?
Name, concentration, amount, diluent, expiration.
What critical information must the nurse ensure the patient remembers during the follow‑up call?
The warning symptoms that require immediate medical contact (e.g., shortness of breath, severe pain, heavy bleeding, fever).
Clamping a chest tube is generally contraindicated. Name 2 acceptable exceptions when a chest tube may be briefly clamped?
Acceptable exceptions: (1) briefly assess for an air leak, (2) briefly replace a chest tube drainage system, (3) removal trial determined by LIP only- would need an order and usually just goes to water seal
Midazolam and fentanyl are commonly used for procedural sedation in IR. What are the reversal agents for each drug?
Flumazenil reverses midazolam
Naloxone reverses fentanyl.
Both must be immediately available at the bedside during any procedural sedation case.
What is a CT-guided lung biopsy used for, and what is the most common post-procedure complication nurses must monitor for in recovery?
A CT-guided lung biopsy is used to obtain tissue samples from pulmonary lesions for histologic diagnosis (e.g., cancer, infection, inflammatory disease). The most common post-procedure complication is pneumothorax.
**A post-procedure chest X-ray is standard to assess for these.
How long is a straight‑draw medication good for after opening?
24 hours.
During the intake, you notice the consent is for a sedation‑required procedure, but the anesthesia consent is missing. Can time-out proceed?
No- required consents must be complete before the time‑out can begin.
What kind of tape should be used to secure the chest tube to the drainage device and how do you tape it?
Place 2 strips of silk tape lengthwise over the connector extending from the chest tube to the drain tubing, then wrap additional tape around both strips to create a banding effect. The connector must remain visible. This prevents accidental disconnection, which could cause a pneumothorax — a medical emergency.
What is the difference between minimal sedation, moderate (conscious) sedation, and deep sedation in terms of patient response?
Minimal sedation: patient is calm but fully responsive, airway intact.
Moderate/conscious sedation: patient responds purposefully to verbal or light touch, airway requires no intervention, spontaneous ventilation adequate.
Deep sedation: patient cannot be easily aroused, responds only to repeated or painful stimulation, and may require airway assistance.
**Patients can shift between levels, requiring continuous monitoring.
Post‑lung biopsy, an initial CXR is negative. Thirty minutes later, the patient develops increasing RR and new mild chest discomfort. What is your next best step?
Escalate and obtain repeat imaging to evaluate for a delayed pneumothorax; prepare oxygen and reassess vitals continuously.
Who verifies medications before they enter the sterile field?
The RN documenter and the RN circulatory (likely who drew up the meds).
A patient refuses site marking, what do you need to do?
Use the special‑purpose wristband with patient name, second identifier, procedure, and site, per IR policy.