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Mediastinal Drainage
Pleural Drainage
Water Seal Chamber
Managing Chest Tubes
Potpourri
100
Chest tubes placed after coronary artery bypass surgery are positioned in this sac.
What is Pericardial
100
This condition is characterized by an accumulation of air between the visceral and parietal pleurae.
What is Pneumothorax.
100
Seeing these in the water seal chamber indicates an air leak in the chest drainage system.
What is Bubbles.
100
What is the time interval for routinely changing a chest tube dressing?
A chest tube dressing should not be changed routinely; only when it is soiled, loose or otherwise compromised.
100
Describe, specifically, the emergency treatment for a patient with a tension pneumothorax whose condition is rapidly deteriorating while equipment is being set up for chest tube insertion.
Needle decompression in the second intercostal space, in the mid-clavicular line.
200
This complication is characterized by muffled heart tones, decreased, decreased cardiac output and increased right atrial pressure.
What is pericardial/ cardiac tamponade
200
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 Tension pneumothorax.
200
This is the name for the up and down motion of the water in the water seal chamber that corresponds to the intrathoracic pressure changes associated with a patient's respirations.
What is Tidalling.
200
A patient with a chest tube is scheduled to go to the radiology department for a chest radiograph. What would you do with the drain and the tubing when the patient is on stretcher, ready for transport.
Disconnect from suction; if stopcock is present on suction, 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 in the tubing.
200
What is the difference between an open pneumothorax and a closed pneumothorax?
Open pneumothorax= chest wall is penetrated Closed pneumothorax= chest wall is intact
300
This action can create negative pressures as high as -400cm H2O in the chest and is no longer recommended for routine postoperative nursing care of patients with mediastinal chest tubes.
What is Stripping the tubing
300
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.
300
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.
300
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.
300
Describe how you would check for the source of an air leak in a chest drainage system when bubbles are present in the water seal chamber.
Momentarily clamp the chest tube starting at the place where the tube leaves the chest. WHen the tube is clamped, look a the water seal chamber. When the clamp is placed distal to the leak, the bubbling will stop. Work your way down the tubing with the clamp to determine the location of the leak.
400
This substance, covalently bonded to some chest tubes, decreases the incidence of catheter thrombosis.
What is Heparin
400
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.
400
Describe what the numbers on the long arm of the water seal chamber mean.
What is The water seal chamber is a U-tube manometer. The numbers are measurements of negative pressure in ch H2O.
400
There has been no evidence of an air leak in the water seal chamber, the lung is fully re-expanded on a chest radiograph, and fluid drainage has been less than 50 cc in the past 24 hours. What procedure can you expect to prepare the patient for?
What is Chest Tube removal.
400
What would you do if you inadvertenly overfilled the water seal chamber above the 2cm line?
Use a needle and syringe and withdraw the extra fluid through the rubber grommet on the front of the drain.
500
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)
500
This amount of fluid (in cc or mL) is required for a pleural efusion to be seen on an upright chest radiograph.
What is 300-500
500
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 to the 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.
500
A mechanically ventilated patient's chest tube has become disconnected from the tubing leading to the drain, and the drain is cracked. Prior to this even, 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 the chest tube into a bottle of sterile saline or sterile water to a depth of approximately 2cm
500
How does PEEP on a ventilator affect bubbling in the water seal chamber when a patient has an air leak from a pneumothorax?
Bubbling will be continuous when PEEP is used.