Set Up
During set up of a new chest tube drainage system, this is the location of where the water is inserted.
What is the blue suction port?
Frequency of assessment and documentation of a chest tube.
What is q4h?
You walk into your patient's room and notice that the chest tube is dislodged from the site. Verbalize what you would do.
What is place a sterile 4x4 over insertion site and tape 3 sides, monitor for respiratory distress, notify the provider?
If the orange suction monitor bellow is not fully expanded to the triangle, you can do this to help it expand more.
What is increase the suction?
Your patient's chest tube has been in for 2 weeks and you notice there isn't very much water in the water seal chamber. Verbalize what you would do.
What is use a 20-21g needle and syringe to add sterile water into the self-sealing diaphragm on the back of the water seal chamber?
The area of the chest tube drainage system that monitors for an air leak. Verbalize the name of the area and point to it on the drainage system.
What is the air leak monitor?
When assessing your patient's chest tube, you notice some bubbling in the water. What does this often indicate?
What is an air leak?
Emergency equipment you should have readily available for patients with a chest tube in place.
What is 4x4s, foam tape, padded hemostats, sterile scissors, and sterile water?
You are doing your safety checks at the beginning of your shift and notice that the patient's chest tube doesn't have any zip ties on it. Verbalize what you would do.
What is secure the connections and add a zip tie to every connecting point that does not contain a luer lock?
You get in report that the patient's chest tube is to water seal. You check the orders and you only have an order for the chest tube to suction. Verbalize what you would do.
What is put the chest tube to suction and clarify orders with the provider?
This regulator is in cmH2O and is per provider orders. It helps control suction. Verbalize the name of the area and point to it on the drainage system.
What is the dry suction control regulator?
Frequency of chest tube dressing changes if it is a chest tube placed by Trauma.
What is q48h?
You walk into your patient's room and the chest tube has become dislodged from the drainage chamber. Verbalize what you would do.
What is place the end of the tube in a container of sterile water to reestablish the water seal and have another nurse set up a new drainage system?
You are assessing your patient's chest tube and note there hasn't been a lot of drainage during your shift. You notify the provider and they ask you to TPA the chest tube. Verbalize what you would do.
What is tell the provider that nursing staff is unable to instill TPA in a chest tube?
You notice the white ball goes up and down in the water seal chamber with inspiration and expiration. Verbalize what this is and if it is an expected finding or not.
What is tidaling and yes, it is expected?
The location of where you would apply suction tubing.
What is the blue suction port?
When assessing chest tube output, you would do this on the chest tube drainage system.
What is mark the drainage on the chest tube drainage system?
The PCT is helping your patient with a chest tube walk in the hallway and you notice the patient is short of breath and their chest tube is not to suction as ordered. Verbalize what you would do.
What is obtain portable suction and hook it up to the chest tube? Also educate PCT to ask prior to getting patient up if the patient needs to be to suction or not.
The patient's mom accidentally tipped over the drainage system when they were at the bedside. Verbalize what you would do.
What is set up a new drainage system and change it out?
The provider changes the dry suction order from -20cmH2O to -30cmH2O. Verbalize what you would do.
What is change the dry suction regulator to -30cmH2O and depress the manual high negativity vent to reduce excess vacuum?
The orange suction monitor bellow must be fully expanded to what area in order to achieve the prescribed dry suction (example: -20cmH2O).
What is the triangle?
List at least 4 respiratory symptoms to watch for while chest tube is in place.
What is cyanosis, decreased O2 sats, rapid or shallow breathing, crepitus, chest pain, excessive breathing, etc.?
Your patient's chest tube was removed by the provider about 1 hour ago. Your patient calls you into the room as the site is bleeding profusely. Verbalize what you would do.
What is hold pressure on the site and notify the provider?
You suspect your patient has an air leak due to bubbling in the system. Verbalize how you would troubleshoot this.
What is break down the site to ensure chest tube is still in place, work down the tubing to determine if there is a hole, if you can't find the leak then change out the drainage system? Notify provider if bubbling doesn't subside after changing the drainage system.
Verbalize where you would document chest tube output with assessments and the running total for all output since chest tube insertion.
What is output (with assessments) and output comment (running total)?