Closed Chest Drainage Flashcards

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Questions and Answers

What type of system is used to restore a collapsed lung or to drain fluid from the pleural cavity?

Closed chest drainage system (correct)

Open chest drainage system

Partial chest drainage system

No chest drainage system

What is the primary function of a one-way valve in a closed chest drainage system?

To allow air and fluid to exit the pleural cavity while preventing air from re-entering.

What will happen to the fluid level in a water seal chamber during inhalation?

Rises (correct)

Falls

Evaporates

Remains the same

What should you do to maintain an adequate seal in a closed chest drainage system?

Keep the drainage system upright and ensure the fluid in the water-seal chamber is at the recommended level. Signup and view all the answers

How do traditional closed-chest drainage systems regulate the amount of suction?

By the height of the water in the suction-control chamber Signup and view all the answers

The Heimlich valve is a __________ valve that allows air to escape from the pleural cavity.

one-way flutter Signup and view all the answers

What should be primarily assessed in a patient using a closed chest drainage system?

Vital signs and respiratory status Signup and view all the answers

What is the purpose of the mobile chest drain?

To allow patients to go home or ambulate while maintaining a closed-chest drainage system. Signup and view all the answers

Assessment of the drainage should include character, consistency, and __________.

amount Signup and view all the answers

The water level in the water seal chamber should drop continuously during exhalation.

False Signup and view all the answers

What is a key part of a closed-chest drainage system that indicates the degree of air leak?

Air-leak meter Signup and view all the answers

When does fluctuation stop in the water-seal chamber?

When the lung has re-expanded, when the tubing is obstructed, or when the suction source is not functioning. Signup and view all the answers

Constant bubbling in the water-seal chamber indicates an air leak.

True Signup and view all the answers

What can an observed air leak indicate?

An accidental dislocation of the chest tube or possible external leaks at the tubing connection sites. Signup and view all the answers

Why should you tape the tubing connection sites?

To prevent disconnection of the tubing. Signup and view all the answers

What does it indicate if bubbling stops?

The air leak may be at the chest tube insertion site. Signup and view all the answers

What should be checked for closed-chest drainage systems with wet-suction control?

Gentle bubbling in the suction-control chamber. Signup and view all the answers

Vigorous bubbling in the suction-control chamber is beneficial.

False Signup and view all the answers

What should you do for dry-suction control systems?

Verify the correct placement of the dial and the float ball. Signup and view all the answers

What happens if the air vent is occluded in dry-suction control?

It prevents drainage and can cause a buildup of pressure, leading to tension pneumothorax. Signup and view all the answers

What should be done if there are clots in the chest tube?

Consult with a physician about milking the tube. Signup and view all the answers

What should you encourage the patient to do regarding lung expansion?

Cough frequently and breathe deeply. Signup and view all the answers

What to do if you see continuous bubbling in the water-seal chamber?

Notify the provider and examine for air leaks. Signup and view all the answers

What should you do before transporting a patient with a chest tube?

Disconnect the system from the suction source. Signup and view all the answers

Patients should keep the drainage system below chest level.

True Signup and view all the answers

What happens after the lung has re-expanded?

The physician may prescribe clamping the tube or disconnecting the suction. Signup and view all the answers

What is the primary goal of closed-chest drainage?

Optimize ventilation and gas exchange by draining air or fluid from the pleural cavity. Signup and view all the answers

What indicates the closed-chest drainage system is not working properly?

Signs of altered oxygenation, such as restlessness and tachycardia. Signup and view all the answers

What should you check first if the drainage system is not functioning?

Check the patency of the chest tube. Signup and view all the answers

What should you do if a chest tube is completely dislodged?

Cover the site immediately with a sterile gauze dressing. Signup and view all the answers

What is pleurodesis?

A procedure that involves instilling a chemical agent into the pleural space. Signup and view all the answers

What can the inflammatory response from pleurodesis lead to?

Creation of scar tissue and adhesions between the pleural layers. Signup and view all the answers

Study Notes

Closed Chest Drainage System Overview

Chest tubes are inserted to restore collapsed lungs or drain pleural cavity fluids, connecting to sealed drainage systems or one-way valves.
These systems prevent air from re-entering the chest during aspiration while allowing fluid and air to exit.

Types of Chambers in Closed Chest Drainage

Single Chamber: Collects smaller amounts of drainage while providing a water seal.
Two Chambers: Allow more precise measurement; one for fluid collection, another for water seal.
Three Chambers: Essential for controlled suction; includes collection chamber, water seal, and suction control.

Water Seal Chamber Functions

Allows air to escape during exhalation and prevents air from entering the pleural space during inhalation.
Tidaling in the water-seal chamber indicates proper function; continuous bubbling signals an air leak.

Suction Control Mechanisms

Wet Suction Control: Regulated by water height; typically filled to 20 cm for adults.
Dry Suction Control: Uses a self-compensating regulator; quieter and independent of fluid replacement.

Monitoring and Maintenance

Regularly check fluid levels in the water-seal chamber to prevent evaporation.
Observe the characteristics and amount of drainage to assess functionality and patient response.

Patient Assessment and Care

Continuous assessment of vital signs, respiratory status, and pain is crucial.
Monitor the chest-tube insertion site for signs of infection or complications, such as subcutaneous emphysema.

Nursing Planning and Implementation

Focus on enhancing gas exchange, positioning for lung expansion, and managing pain.
Scheduled dressing changes, maintaining aseptic technique, and ensuring a closed system are essential.

Evaluation of Patient Progress

Ensure that respiratory rates remain normal and oxygen saturation stays above 90%.
The patient should ambulate safely and demonstrate an increase in endurance over time.

Troubleshooting Air Leaks

Continuous bubbling in the water-seal chamber may indicate air leaks due to dislodged tubes or connection site issues.
Tape connection sites to prevent disconnection and keep sterile gauze available for emergencies.

Key Considerations for Special Situations

Use sump ports in drainage systems for patients with significant blood loss for autotransfusion.
Adjust suction pressures based on individual patient needs, especially those with large air leaks or compromised lung function.### Chest Tube Management
Continuous bubbling in drainage systems may indicate an air leak and should be reported to the provider.
Momentarily applying padded rubber-tipped clamps on the drainage tubing can help identify the source of the air leak.
If bubbling stops, the leak may be near the chest tube insertion site; if it continues, further investigation is needed upstream.

Closed-Chest Drainage Systems

For wet-suction systems, gentle bubbling in the suction-control chamber is normal; keep fluid at the recommended level (usually 20 cm).
Vigorous bubbling can disturb the patient and accelerate water evaporation.
For dry-suction systems, ensure the suction dial is correctly set and the float ball is at the appropriate level.

Issues with Proper Drainage

Occlusion of the air vent may lead to drainage failure and potential tension pneumothorax.
Keep drainage tubing coiled or flat to avoid kinks and maintain it below the insertion site to prevent fluid backflow.
Avoid dependent loops and do not strip the tubing to prevent increased negative pressure that could damage lung tissue.

Patient Care and Interventions

Encourage patients to cough and breathe deeply to aid lung expansion and fluid drainage.
Sitting upright may alleviate discomfort during these activities.
Monitor for pain and provide analgesics to support patient comfort during deep breathing and mobility exercises.

Emergency Procedures

Always have rubber-tipped clamps accessible in case of system malfunction; patients should report difficulty breathing immediately.
If the drainage system is disrupted or overfilled, promptly prepare a new drainage system for quick replacement.

Handling Disconnections and Air Leaks

In case of tube disconnection, instruct the patient to cough and immediately utilize sterile water to submerge the tube’s end until reattachment.
Check for bubbling in the water-seal/air-leak meter to assess for air leaks; do not clamp if bubbling indicates an air leak.

Clamping Procedures

If the drainage system tips over or gets disrupted, clamp the chest tube briefly during replacement.
Excessive bubbling indicates potential leaks; incrementally clamp the tubing to find the leak's location.

Tension Pneumothorax Awareness

If a tube is completely dislodged, cover the site with a sterile dressing to prevent air from escaping which could lead to tension pneumothorax.
Monitor vital signs closely for signs of tension pneumothorax, such as hypotension and absent breath sounds.

Pleurodesis

For recurrent pneumothorax cases, a pleurodesis procedure involves instilling talc into the pleural space to promote adhesion and reduce recurrence.
Monitor patients closely during this process and be ready to address potential complications like tension pneumothorax.

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Description

Enhance your understanding of closed chest drainage systems with these flashcards. Each card focuses on key concepts, definitions, and clinical applications related to chest tubes and their role in managing pleural cavities. Perfect for nursing and medical students preparing for ATI assessments.