Chest Tubes
Pneumothorax, hemothorax, empyema, post-surgery, persistent pleural effusion.
What are some indications for a chest tube?
Exposed blood vessels, organs, nerves, or anastomotic sites
untreated osteomyelitis
nonenteric or unexplored fistulas
Nectrotic tissue with eschar present
Malignancy in the wound
What are contraindications for a wound vac
What type of drain is listed as drain #1?
What is a hemovac drain?
Decreased level of consciousness
Head or neck surgery or radiation therapy
Facial trauma
Impaired swallowing
Prolonged nothing-by-mouth (NPO) status
Inability to ingest required nutrients orally
Failure to meet nutritional needs from oral feedings
Another nutritional deficit
What are indications for enteral feedings
Pain, erythema, edema, streak formation, palpable venous cord
What are signs of phelbitis?
BVM with appropriate-sized mask, oxygen source, occlusive dressing, suction source, bottle of sterile water, marker
What is equipment that should be kept at the bedside for a patient with a chest tube?
May be cut into shapes or in a spiral fashion, considered single use only. Can be black, white or gray. Discard any unused pieces when the dressing change is complete.
What is the foam sponge used for the wound vac?
If the patient has this type of drain #2, ensure that it has a sterile safety pin in the drain tubing. Crimp the head of the safety pin with forceps to prevent the pin from opening and scratching the patient. Sometimes covered with a gauze dressing or a wound pouch. Use caution to avoid dislodging the drain; do not accidentally pull on it while positioning the gauze.
What is a Penrose drain?
Draw 30 ml of air into a 60-ml enteral syringe, attach the syringe to the proximal end of the enteral feeding tube, and inject the air into the tube. Listen over epigastric area with stethoscope.
Draw back on the syringe slowly and aspirate the total amount of gastric contents. If necessary, reposition the patient to facilitate the withdrawal of fluid from the tube.
Note the amount of residual volume. Observe the volume of aspirate for changes.
What is checking an NG Tube for placement prior to feedings.
Every 7 days or when visibly loosened or soiled.
How often are Central Line, PICC, and Midline Catheter dressing changes done?
Continuous: not intermittent
80-100
Enough so that the orange bellows in the window
What are the settings for the wall suction?
Check the display reads ON, and it is set to the appropriate pressure level and mode.
Ensure the clamps are open and the tubing is not kinked.
Listen with a stethoscope or move a hand over the dressing edges.
Once the area is identified, trim the loose or soiled transparent film dressing, cleanse and dry, and then patch the area with an additional layer as necessary.
How do you troubleshoot a wound vac air leak?
This type of drain #3 has a bulb at the end of the tubing. Check the practitioner’s order to determine whether the drain tube needs self-suction, wall suction, or no suction.
What is a Jackson-Pratt or JP Drain?
18 inches
What is the length the feeding set bag must be hung above the top of the feeding pump to achieve proper accuracy?
Introducing ENFit with leur lock
Central line, ART line, PICC line, Midline, Port line
Which of the above are not central line(s)?
What are ART line and Midline?
What Mnemonic is used for chest tube assessment?
FOCA
Fluctuation in the water seal chamber
(Manual pressure release button) ball drop/ purulent drainage
Output
Color of drainage
Air leak assessment
How often the nurse should obtain wound measurements.
What is with each dressing change?
Instruct concerning anticipated postoperative drainage, the expected progress of wound healing and drainage volume, and the estimated date of drain removal as volume diminishes.
Instruct on how to empty the drainage and record the amount. Ask the patient or the family to keep a record of amounts emptied and to bring the record to the next outpatient visit.
Explain how to care for the drain when turning, ambulating, and performing activities of daily living. Emphasize that direct pulling or traction on the drain must be avoided.
What are instructions to the patient and family on care of drains at home?
Tachycardia, Tachypnea, Hypoxemia Cyanosis, Wheezing or Rales, GI contents found in pulmonary secretions
What are signs and symptoms of aspiration of tube feeding?
Use Push-Pull method to create turbulence within the line.
What is the method for flushing a CVC?
Place the end of the tube in sterile water
Place an occlusive dressing taped on 3 sides
What do you do for a chest tube that is disconnected or comes out?
Periwound erythema, warmth, edema, pain, maceration; fever; elevated WBC count; cloudy or foul-smelling wound drainage; excess bleeding; changes in tissue color in wound bed (bright, red or gray, and pale); new tunneling or undermining; enteric contents in the wound bed or in collection canister.
What needs to be reported to the provider?
Pinch the tubing close to the skin between the thumb and forefinger of one hand.
Keep this hand in place while milking the tubing.
With the thumb and forefinger of the other hand, pinch the tubing just adjacent and distal to the other finger and thumb.
While keeping the tubing pinched, slide the distal thumb and forefinger down the tubing, toward the bulb.
How are clots removed from the JP drain?
Intestinal obstruction, intractable vomiting, ileus, massive GI bleeding, intractable diarrhea, pancreatitis, fistula, hemodynamic instability
What are contraindications to enteral nutrition?
When accessing a CVC for lab draw or to start a medication, disinfect the connection surface and sides of the needless connector using vigorous mechanical scrubbing for a minimum of __________ seconds.
What is 20 seconds?