Care of Patient With Chest-tube Drainage
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Care of Patients with Pleural Disorders and Chest Tube Drainage
Transcript of Care of Patient With Chest-tube Drainage
Care of Patients with
Pleural Disorders and Chest Tube Drainage
Instructional Activity Sequence for TBL
Preparation(Pre-class)
Readiness AssuranceDiagnosis-Feedback
1hr 50 mins of class time
Application of Course Concepts
2 hours of clinical skills practice
1. Individual
Study
2. Individual
Test (10mins)
3. Team Test
(15mins)
4. Appeals (5mins)
5. Instructor Input (1hr 20 mins)
6. Application Orientated Activities
Team Test
Case Scenario
Peter, 20-year-old man, with no past medical history or involve in any accident,
was admitted to the hospital. He developed SOB and pleuritic chest pain
when having dinner with his family. He has stopped smoking 3 years ago.
His vital signs is BP 112/70mmHg, 89 b/min, RR 28/min, SpO2 95%, T: 36.7. An initial assessment revealed hyperresonance to
percussion
1. The most probable diagnosis
for Peter is:
A: Empyema
B: Hematoma
C: Spontaneous pneumothorax
D: Open pneumothorax
E: Pleural effusion
Blebs are weakened out-pouchings in the upper lung,
which can rupture, causing pneumothorax.
Spontaneous pneumothorax
Pneumothorax
Pneumothorax
Traumatic Spontaneous
Open Close
Tension Pnenumothorax
Mediastinum Shift
SHOCK
DEATH
Air leak into pleural space
during inspiration
Air prevents from leaking out
during expiration
Increased thoracic pressure
2. To determine whether Peter develops
tension pneumothorax, the nurse assesses
the patient specifically for:
A: Pleuritic chest pain
B: Diminished breath sounds on the
affected side
C: Dull percussions on the injured side
D: Decreased chest movement on the
affected side
E: Severe respiratory distress and tracheal
deviation
Traumatic /
Spontaneous
Pneumothorax
Tension
Pneumothorax
Hemothorax
SIMILARITIES
DIFFERENCES
Traumatic /
Spontaneous
Pneumothorax
Tension
Pneumothorax
Hemothorax
SIMILARITIES
•Pleuritic Chest pain
•Absence/Diminished breath sound
•Unequal chest expansion
•SOB
DIFFERENCES
•Hyperresonance to
percussion
•Severe Respiratory
Distress
•Hypotension
•Distended neck vein
•Tracheal deviation
•Dullness to
percussion
•Hypotension
Pleural Effusion
• Excess fluid in the pleural cavity
• Causes
– Increased capillary hydrostatic pressure
– Increased capillary permeability
– Decreased plasma oncotic pressure
– Obstruction of lymphatic drainage
Treatments
ThoracentesisChest-tube insertion
3. The chest tube drainage
system relieves Peter’s
pneumothorax by
A: Enhancing chest wall movement
B: Injecting air into the pleural space
C: Preventing air from entering the cavity
D: Restoring negative pressure in the pleural
space
E: Increasing the amount of pleural fluid
4. Which 3 chambers are found
in a closed chest drainage
system?
• Water seal, pressure, and drainage
collection chambers
• Water seal, suction control, and drainage
collection chambers
• Gravity, suction control, and drainage
collection chambers
• Pressure, water seal, and gravity
chambers
5. The main purpose of the water seal
chamber is to:
A: Prevent air from going into his chest
B: Detects air leaks
C: determines the amount of suction applied
D: Provide high negative pressure
E: Reflect the amount of drainage in the
pleural space
Chest Drainage
System
Collection
Chamber
Water
Seal Chamber
Suction
Control Chamber
Chest Drainage System
Collection Chamber Water Seal Suction Control
•Drain air & fluid from the
pleural space
•Observe & record drainage
Chest Drainage System
Collection Chamber Water Seal Suction Control
• 2 cmH2O
•Act as one-way valve by bubbling out air
•Observe fluctuations in the water level
Chest Drainage System
Collection Chamber Water Seal Suction Control
•Connected to suction wall
• Remove air & fluid more
quickly
Nurses’ Roles
Care of Patient
with Chest Tube
Chest Tube
Removal
Chest Tube
Insertion
6. Which of the following is the most
appropriate position for Peter when
preparing him for chest-tube insertion
A: Prone position with head to the side
B: Lateral supine position with the legs bent
C: Upright seated position, leaning over a
table
D: Semi-Fowler’s position with a pillow
under the back
E: Supine position with the legs straighten
3rd, 4th 5th or 6th intercostal
space in the mid axillary
line
Chest Tube Insertion (Before)
• Informed consent
• Administer pain medication
• Prepare equipment
• Set up drainage system
• Obtain baseline vital signs
• Position patient
Chest Tube Insertion (During)
• Assist Dr with chest tube insertion
• Monitor patient’s condition
• Provide emotional support
• Apply dressing on the insertion site
• Taped all connections
Chest Tube Insertion
(Immediately After)
• Call for chest x ray
• Monitor patient’s vital signs hrly X 6hrs
• Administer pain medications
• Observe complications
• Assess drainage system
Care of Patient
with Chest Tube
Chest Tube
Removal
Chest Tube
Insertion
Care of Patient with Chest-tube
drainage system
I
Assess
Insertion Site
Check
Chest-tube
Drainage System
Monitor & Maintain
Respiratory
Function
Monitor & Maintain
Respiratory Function
• Monitor vital signs & SpO2
• Auscultate breath sounds
• Encourage deep breathing & coughing
• Encourage use of incentive spirometery
• Prop up patient
• Reposition patient
Assess Insertion Site
7. When palpating around Peter’s chest
tube insertion site, you detect crepitation
and tissue swelling, you suspect:
A: Infection
B: Subcutaneous emphysema
C: Tension Pneumothorax
D: Unresolved pneumothorax
E: Bleeding
Assess Insertion Site
• Bleeding
• Infection
• Subcutaneous emphysema
Check Chest Drainage System
• Tubing avoid dependent loops, kinking & clamping
• Connection taped securely
• Drainage bottle below level of patient’s chest
Check Chest Drainage System
• Check water seal
• Level
• Bubbling
• Fluctuations
• Check suction pressure
• Assess drainage
Chest Tube Drainage
8. Peter needs to be transported to the x ray
department. The concern during transport
include assure that:
A: the chest tube is clamped
B: the chest tube bottle is below the
insertion site
C: Suction tubing is open to air
D: B & C
E: A & B
9. At the X ray department, you notice the
drainage tubing was disconnected from the
drain. Your first action is to
A: Re-established connection
B: Clamp Peter’s chest tube immediately
C: Notify doctor immediately
D: Send him back to the ward immediately
and change another drainage system
E: Check Peter’s vital signs
Common Problems
• Disconnection of drainage tubing from drain
– Clamp with artery forceps
– Re-establish connection ASAP
– Notify Dr
– KIV chest x ray
• Lack of Drainage
– check tubing for kinks or obstruction
Common problems
• Collecting bottle fall over
– Re-establish water seal level
• Intrapleural drain fall out
– Tie the purse-string suture
– Cover with gauze and pressure bandage
– Notify Dr
– Monitor Patient
Care of Patient
with Chest Tube
Chest Tube
Removal
Chest Tube
Insertion
10. The doctor plan to remove the Peter’s
chest tube. Which of the following signs
suggests the pneumothorax has resolved?
A: An air leak in the water seal chamber
B: Bubbling in the suction control chamber
C: Clear lung sound that extend to the
periphery
D: More than 100mil of fluid in the collection
chamber
E: C & D
Removal of Chest Tube
(Indicator)• Little to no drainage
• Normal breathing
• Fluctuations in water seal stopped
• Chest X ray shows lung re-expansion with
no residual air or fluid
• Able to tolerate chest tube clamping
• Monitor respiratory status
Removal of Chest Tube
• Administer pain medication
• Prepare equipment
• Patient hold his breath, Dr tie the purse string &
nurse remove the chest tube in one quick
movement
• Apply dressing
• Monitor respiratory status
• Arrange for chest X ray
Care of Patient
with Chest Tube
Chest Tube
Removal
Chest Tube
Insertion
Pleural Conditions
Instructional Activity Sequence for TBL
Preparation(Pre-class)
Readiness AssuranceDiagnosis-Feedback
1hr 50 mins of class time
Application of Course Concepts
2 hours of clinical skills practice
1. Individual
Study
2. Individual
Test (10mins)
3. Team Test
(15mins)
4. Appeals (5mins)
5. Instructor Input (1hr 20 mins)
6. Application Orientated Activities
Clinical Lab Skills
• Prepare Equipment
• Set up drainage system
• Apply dressing on the insertion site
• Taped all connections
• Documentation
Video Show
Mosby’s Chest Tubes and Closed
Chest Drainage SystemRD539Vhe2007
![Indikationen und Techniken der Drainageeinlage · Abklemmen der Drainage • A bubbling chest tube should never be clamped. [C] • Drainage of a large pleural effusion should be](https://static.fdocuments.net/doc/165x107/5e1f0ffea5187e7ff11923a4/indikationen-und-techniken-der-drainageeinlage-abklemmen-der-drainage-a-a-bubbling.jpg)
