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16 Cards in this Set
- Front
- Back
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Physician's order is needed for:
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- clamping chest tube (usually for pneumothorax), unless emergency disconnection
- instillation of TPA (by MD) - gravity drainage - chest tube removal - suction setting other than -20cm H2O (default) |
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Chest tube emergency kit
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2 clamps
petroleum gauze gloves |
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Assessment/documentation
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- cardiorespiratory function (q4h)
- chest tube patency, tubing, D+I dressing, amount/type of drainage, air leak, apppropriate suction (hourly) |
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When to notify MD
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- sudden increase/decrease in drainage
- ongoing large losses of chest drainage - changes in colour/consistency - signs of site infection - relevant changes in patient status (i.e. respiratory, abdo girth, VS) |
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Tubes inserted in IGT will have a stopcock which should be secured on both sides using
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waterproof tape
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Location of chest tube collection system
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- below level of patient's chest always
- excess tubing coiled, never hung/draped over side of bed |
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Gravity drainage / disconnected from suction
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- suction port must be uncapped and free of obstruction always to allow air to exist
- prevent tension pneumothorax |
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What if negative pressure window doesn't show YES or intermittently?
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- negative pressure not established, check connections and ensure no leaks, replace system if still no YES
- intermittently YES = gravity drainage |
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What happens if system tips over?
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- don't need to replace, unless drainage fluid mixes with water from air leak meter
- if drainage spilled into other columns in same chamber, can be tipped back |
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Where can air leaks occur?
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in patients lung (pleaural, mediastinal or pericardial space, at insertion site, in chest tube or anywhere along chest tube collection tubing
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How do you know when there's an air leak?
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bubbling in air leak meter, also indicates size 1-7
Notify MD of size, progress, continuous/intermittent |
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If air leak present
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check tubing/connections, replace system if appropriate
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small arm of air leak
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indicates accumulating negative pressures
- consult MD whether to relieve pressure by depressing high negativity relief valve (black button on top) at top of system until water level stops decreasing |
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Milking and stripping tubes
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only on 4D/CCU standard of practice, or if practitioner has knowledge/skill/judgment
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Accidental removal/dislodgement of drain
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occlude site with gloved hand
call for help helper places petroleum occlusive gauze over site monitor patient status notify MD document |
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Documentation
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- chest tube care record (hourly)
- flowsheet (totals) - progress notes |
