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Where and why are chest tubes inserted?
- Pleural space
- Drain fluid, blood, air
- Reestablish - pressure
- Facilitate lung expansion
- Restore normal IPP
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How are water seals created?
Adding 2cm of sterile water to the chamber
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What does the water seal allow to happen?
Air to exit pleural space exhaling but no air inhaling
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Suction (-20) results in what?
Continuous bubbling in the suction chamber
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What is tidaling? Seen in what chamber?
- movement of fluid level with respiration
- water seal chamber only
- if it stops means there is lung reexpan or obstruction
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Sxs of a need for chest tube?
dsypnea, distended neck veins, poor circ, cough, ↓ breath sounds
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Preprocedure
consent, teaching, allergies, supine/SF, prepare system (water chamber) before insertion
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Chest tube insertion Up(shoulder)/Down (posterior)
- Up- if pneumothorax
- Down-if pleural effusion or hemothorax
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Post procedure
- Assess vitals q 4
- Check water seal level q2 (add fluid if needed)
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How often do you document?
Hourly for 1st 24 hours then q8
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Report what?
- report 70ml/hr or more
- cloudy or red drainage
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What are expected findings in the system?
- Tidaling- water seal chamber
- Bubbling- suction chamber
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What should be kept at the bedsite at all times?
- 2 enclosed hemostats
- sterile water
- occlusive dressing
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Who can clamp a chest tube and why would it need to be done?
- Only dr bc can cause tension PT
- if air leak, damaged system, change in system, disconnection
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What complications can occur?
- Air leak
- Tension PT
- Disconnection
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How to assess for lung expansion?
ask pt to cough if no bubbling then there is no air leak
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Finding of an air leak how to fix
- Bubbling in the water seal chamber
- change system or tighten connection
- if Dr order then use padded clamp (find leak)
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Tubing separates and how to fix?
- Ask pt to EXHALE and COUGH to remove AIR
- clean tips and reconnect tubes
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Drainage system compromised?
immerse in sterile water and reestablish water seal chamber
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If chest tube is removed?
Occlusive dressing placed at site but only 3 sides to let air come out still
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What causes tension PT?
- sucking chest wounds
- prolonged clamping
- kinks
- obstruction
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Why to ask pt to breath out and bear down?
increases intrathoracic pressure and prevents air embolism
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