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Questions and Answers
What is the primary position recommended to prevent air embolism during catheter insertion?
What is the primary position recommended to prevent air embolism during catheter insertion?
Which of the following steps is NOT part of the post-catheter placement process?
Which of the following steps is NOT part of the post-catheter placement process?
During the dressing change of a central line, what should be done first?
During the dressing change of a central line, what should be done first?
What solution is recommended for cleaning the catheter site during dressing change?
What solution is recommended for cleaning the catheter site during dressing change?
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What is the purpose of measuring the external PICC length during dressing changes?
What is the purpose of measuring the external PICC length during dressing changes?
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Which technique is especially beneficial for accessing deeper central vessels?
Which technique is especially beneficial for accessing deeper central vessels?
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What is a primary complication associated with central line insertion?
What is a primary complication associated with central line insertion?
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Which type of catheter is specifically used for monitoring heart function and blood flow?
Which type of catheter is specifically used for monitoring heart function and blood flow?
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Which of the following is a potential complication of a central line?
Which of the following is a potential complication of a central line?
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What technique should be used when managing catheters to prevent infections?
What technique should be used when managing catheters to prevent infections?
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Intra-arterial catheters are primarily used for which purpose?
Intra-arterial catheters are primarily used for which purpose?
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What condition could occur as a result of catheter dislocation?
What condition could occur as a result of catheter dislocation?
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Which of the following complications is NOT associated with central line insertion?
Which of the following complications is NOT associated with central line insertion?
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What is the primary function of a chest tube?
What is the primary function of a chest tube?
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Which condition is characterized by air trapped in the pleural space under positive pressure?
Which condition is characterized by air trapped in the pleural space under positive pressure?
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Which of the following is not an indication for chest tube placement?
Which of the following is not an indication for chest tube placement?
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What is the first step in the setup of a chest drain?
What is the first step in the setup of a chest drain?
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What procedure is performed to prepare the skin before chest tube insertion?
What procedure is performed to prepare the skin before chest tube insertion?
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What is the common complication associated with both pneumothorax and hemothorax?
What is the common complication associated with both pneumothorax and hemothorax?
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What type of fluid accumulates in the chest cavity during chylothorax?
What type of fluid accumulates in the chest cavity during chylothorax?
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What is the appropriate incision size for inserting a chest tube?
What is the appropriate incision size for inserting a chest tube?
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Where should the tube be inserted for optimal placement?
Where should the tube be inserted for optimal placement?
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Which of the following actions is unnecessary for the management of chest tubes?
Which of the following actions is unnecessary for the management of chest tubes?
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What should be monitored at least every two hours for patients post-thoracostomy?
What should be monitored at least every two hours for patients post-thoracostomy?
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What is one of the key nursing responsibilities regarding the chest tube?
What is one of the key nursing responsibilities regarding the chest tube?
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What equipment is necessary to manage a chest tube effectively?
What equipment is necessary to manage a chest tube effectively?
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Why is it important to regularly assess the chest tube site?
Why is it important to regularly assess the chest tube site?
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What position should the patient be assisted into to promote proper drainage?
What position should the patient be assisted into to promote proper drainage?
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What is the primary purpose of applying suction to the drainage system?
What is the primary purpose of applying suction to the drainage system?
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What complication can arise from clamping a chest drain without medical order?
What complication can arise from clamping a chest drain without medical order?
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How high should a chest drain be positioned in relation to the patient's chest?
How high should a chest drain be positioned in relation to the patient's chest?
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What does continuous bubbling in the water seal chamber indicate?
What does continuous bubbling in the water seal chamber indicate?
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What is the Seldinger technique primarily used for?
What is the Seldinger technique primarily used for?
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Which of the following is NOT an indication for central venous catheterization?
Which of the following is NOT an indication for central venous catheterization?
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What should be done to ensure the water seal in the drainage unit is maintained?
What should be done to ensure the water seal in the drainage unit is maintained?
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Which vein is NOT a common access site for placing a central venous catheter?
Which vein is NOT a common access site for placing a central venous catheter?
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What should you do if you notice an unexpected cessation of oscillation in the water seal chamber?
What should you do if you notice an unexpected cessation of oscillation in the water seal chamber?
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What is the purpose of placing a patient in Trendelenburg position during catheter insertion?
What is the purpose of placing a patient in Trendelenburg position during catheter insertion?
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Which step should be performed immediately after catheter placement?
Which step should be performed immediately after catheter placement?
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What is the recommended procedure after removing the old dressing during a central line change?
What is the recommended procedure after removing the old dressing during a central line change?
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Which is a key requirement to maintain sterility during the dressing change process for a central line?
Which is a key requirement to maintain sterility during the dressing change process for a central line?
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What is the maximum frequency for changing the dressing and catheter parts for a central line as per protocol?
What is the maximum frequency for changing the dressing and catheter parts for a central line as per protocol?
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What is the risk of clamping a chest drain without a medical order?
What is the risk of clamping a chest drain without a medical order?
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What should the water seal in the drainage unit be maintained at?
What should the water seal in the drainage unit be maintained at?
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Which of the following is a common access site for central venous catheter placement?
Which of the following is a common access site for central venous catheter placement?
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What should be done if an air leak is suspected during chest tube management?
What should be done if an air leak is suspected during chest tube management?
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What is one reason for central venous catheterization?
What is one reason for central venous catheterization?
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What position should the patient avoid to prevent complications with the chest tube?
What position should the patient avoid to prevent complications with the chest tube?
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What is the minimum frequency for monitoring drain output in patients with a chest tube?
What is the minimum frequency for monitoring drain output in patients with a chest tube?
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Which technique is primarily used for placing a central intravenous line?
Which technique is primarily used for placing a central intravenous line?
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What action is important to prevent pulling on a chest drain?
What action is important to prevent pulling on a chest drain?
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Which of the following is a key nursing responsibility during chest tube management?
Which of the following is a key nursing responsibility during chest tube management?
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What should be done with the collection container of a chest tube?
What should be done with the collection container of a chest tube?
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What should be assured when securing all connections in chest tube management?
What should be assured when securing all connections in chest tube management?
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What is the recommended approach to handle suction in patients with a chest tube?
What is the recommended approach to handle suction in patients with a chest tube?
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Why is routine stripping or milking of chest tubes discouraged?
Why is routine stripping or milking of chest tubes discouraged?
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How should suction levels be managed for a patient with a chest tube?
How should suction levels be managed for a patient with a chest tube?
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What condition is characterized by blood collection in the pleural space?
What condition is characterized by blood collection in the pleural space?
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What is a primary reason for inserting a chest tube?
What is a primary reason for inserting a chest tube?
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Which of the following signs indicates a tension pneumothorax?
Which of the following signs indicates a tension pneumothorax?
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What is the initial step in the process of preparing for chest tube insertion?
What is the initial step in the process of preparing for chest tube insertion?
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What is one of the primary management focuses for central catheters?
What is one of the primary management focuses for central catheters?
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Which of the following conditions is NOT an indication for chest tube placement?
Which of the following conditions is NOT an indication for chest tube placement?
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What should be used to clean the skin before inserting a chest tube?
What should be used to clean the skin before inserting a chest tube?
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Which complication is associated with the insertion of a central line?
Which complication is associated with the insertion of a central line?
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What type of catheter is specifically utilized for right heart catheterization?
What type of catheter is specifically utilized for right heart catheterization?
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What complication arises from a tension pneumothorax?
What complication arises from a tension pneumothorax?
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What is one consequence of arterial injury during central line insertion?
What is one consequence of arterial injury during central line insertion?
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What fluid accumulates in the chest cavity during chylothorax?
What fluid accumulates in the chest cavity during chylothorax?
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When managing a central line, which technique is crucial for preventing infections?
When managing a central line, which technique is crucial for preventing infections?
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Which of the following complications is related to central line use and involves an air leak?
Which of the following complications is related to central line use and involves an air leak?
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What role does ultrasound guidance play during central line insertion?
What role does ultrasound guidance play during central line insertion?
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What is a potential effect of catheter dislocation?
What is a potential effect of catheter dislocation?
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Study Notes
Nursing Care for Patients with Central Lines & Chest Tubes
- A chest tube is a plastic tube used to drain fluid or air from the chest.
- Pneumothorax is a collection of air outside the lung but within the pleural cavity.
- Tension pneumothorax is a severe condition where air is trapped in the pleural space under pressure, displacing mediastinal structures and compromising cardiopulmonary function.
- Hemothorax is a condition where blood collects in the pleural space.
- Chylothorax is a rare, serious condition where lymph (chyle) accumulates in the chest cavity, originating from the digestive system. Lymph contains white blood cells and proteins.
- Pleural effusion is the buildup of fluid between the tissues lining the lungs and chest cavity.
Indications for Chest Tube Placement
- Pneumothorax (collapsed lung)
- Penetrating chest trauma
- Severe blunt chest trauma
- Hemothorax
- Chylothorax
- Symptomatic pleural effusion
- Postoperative use in thoracic surgery
Chest Drain Set Up
- Perform hand hygiene.
- Prepare equipment and drain as per manufacturer instructions.
- Open drain packing in an aseptic manner.
- Insert the chest tube through a 1-inch (2.5 cm) skin incision between ribs to the correct spot.
- Clean the skin with antiseptic.
- Administer a local anesthetic to numb the area.
- Make a small incision and gently open a path for the drain.
- Insert the tube at the fourth (or fifth) intercostal space. Position the tube in the mid-axillary or anterior axillary line.
Nursing Care for Patients with Chest Tubes
- Apply suction to drain if ordered.
- Secure drain and tubing and the patient.
- Secure all connections with cable ties.
- Perform hand hygiene.
- The evidence suggests that routine stripping or milking of chest tubes is unnecessary and may harm by tissue entrapment.
- Monitor the drainage system.
- Check for air leaks, continuous bubbling, and ensure the water seal is maintained at 2 cm.
- Monitor respiratory status.
- Assess pain and provide pain relief.
- Provide overall supportive care.
- Make sure the patient does not lie on the chest tube or that it is pulled.
- Keep the drainage container upright and below the chest level.
- Assist the patient to a sitting position.
- Continuously monitor the drainage system.
- Monitor the patient's vital signs and medical apparatus output continuously.
- Ensure the drainage system is secured to the patient.
- Monitor the drainage output every 8 hours.
- Do not clamp the chest drain unless ordered by medical staff.
- Never lift the drainage system above chest level.
- Tubing should be anchored to the patient to prevent pulling.
- Suctions should be ordered by medical staff.
- Air leaks might show as intermittent bubbling during exhalation or coughing.
- Continuous bubbling indicates a large air leak.
- Oscillation (rise and fall with respiration) is normal. Unexpected cessation may indicate blockage.
Equipment
- Chest drainage bottles (see below)
- Adequate length (1.5-2 m) of sterile, transparent, plastic tubing (e.g., vinyl or Silastic)
- Appropriate sterile connectors
- Adhesive tape
- Angled clamps (2) for clamping the tube
- Distilled water to fill the drainage bottle
- Thoracostomy (Minimally invasive procedure where a thin plastic tube is inserted into the pleural space)
Chest Drain Management
- Place the chest tube in the correct spot confirmed by an X-ray.
- Secure to a drainage device.
- Assess the chest tube site to prevent dislodgement and infection.
- Manage effective suction and drainage.
- Provide pain relief.
- Monitor respiratory status.
- Provide overall supportive care.
- Mark time and fluid level on the drainage chamber.
- Raise drainage system to chest level upon checking patency. Clamp tube when moving patient.
Nursing Care for Patients with Central Lines
- A central line is a long IV that goes to a vein near or inside the heart.
- It is used to deliver medicine, fluids, blood or nutrition.
- The three main insertion sites are internal jugular, common femoral, and subclavian veins.
- Indications for central venous catheterization include inadequate peripheral venous access for things like chemotherapy or antibiotics, central venous pressure monitoring, hyperosmolar or sclerosing substance infusions (like blood transfusions or IV alimentation), and hemodialysis.
- The patient can undergo various medical tests.
- The Seldinger technique is a common central line insertion method.
- Complications of venous central lines include arterial or venous injury, bleeding, and hematoma formation. Ultrasound guidance can help reduce these risks.
- Common types of central venous catheters include long venous catheters and implanted ports.
- Different central venous catheters can include swan ganz catheters.
- Various potential complications following insertion include CLABSI, collapsed lung, delayed pneumothorax, artery puncture, nerve/vein injury, blood clots, air bubbles, irregular heartbeats, catheter dislocation, subcutaneous hematomas or haemthorax.
Post Catheter Placement
- Ports flushed with saline or sterile water.
- Secure catheter with sutures.
- Cover with sterile dressings.
- Obtain chest x-ray post-procedure
- Follow protocol for changing dressings and catheter parts (every 7 days).
Dressing of Central Line
- Perform hand hygiene.
- Apply sterile gloves, mask and clean gloves.
- Instruct the client to turn their head away from the site or to wear a mask.
- Remove the old dressing and discard.
- Remove stabilization devices to avoid dislodging the catheter.
- Inspect the catheter, site, and surrounding skin.
- Compare measures of external PICC length to the baseline readings.
- Clean the site and catheter tubing with chlorhexidine and let it dry. Apply new catheter dressing.
- Use sterile film dressing, over the insertion site.
- Remove and discard gloves.
- Perform hand hygiene.
- Date, time, initial, and attach labels to the dressing.
Nursing Care for Patients with Arterial Lines
- Arterial catheters are used for blood pressure monitoring and sampling.
- Important to follow aseptic technique when handling central catheters to avoid infection.
- Place the patient in Trendelenburg position to prevent air embolism.
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Description
This quiz covers essential nursing care information for patients with chest tubes and central lines, including conditions like pneumothorax, hemothorax, and pleural effusion. It explores indications for chest tube placement and the management of these critical care situations. Test your knowledge and enhance your nursing skills!
