Questions and Answers
What type of system is used to restore a collapsed lung or to drain fluid from the pleural cavity?
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?
What should you do to maintain an adequate seal in a closed chest drainage system?
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How do traditional closed-chest drainage systems regulate the amount of suction?
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The Heimlich valve is a __________ valve that allows air to escape from the pleural cavity.
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What should be primarily assessed in a patient using a closed chest drainage system?
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What is the purpose of the mobile chest drain?
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Assessment of the drainage should include character, consistency, and __________.
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The water level in the water seal chamber should drop continuously during exhalation.
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What is a key part of a closed-chest drainage system that indicates the degree of air leak?
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When does fluctuation stop in the water-seal chamber?
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Constant bubbling in the water-seal chamber indicates an air leak.
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What can an observed air leak indicate?
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Why should you tape the tubing connection sites?
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What does it indicate if bubbling stops?
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What should be checked for closed-chest drainage systems with wet-suction control?
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Vigorous bubbling in the suction-control chamber is beneficial.
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What should you do for dry-suction control systems?
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What happens if the air vent is occluded in dry-suction control?
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What should be done if there are clots in the chest tube?
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What should you encourage the patient to do regarding lung expansion?
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What to do if you see continuous bubbling in the water-seal chamber?
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What should you do before transporting a patient with a chest tube?
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Patients should keep the drainage system below chest level.
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What happens after the lung has re-expanded?
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What is the primary goal of closed-chest drainage?
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What indicates the closed-chest drainage system is not working properly?
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What should you check first if the drainage system is not functioning?
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What should you do if a chest tube is completely dislodged?
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What is pleurodesis?
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What can the inflammatory response from pleurodesis lead to?
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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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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.