Chest Tubes | Nursing Care for the Patient with a Chest Tube NCLEX Review
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Chest Tubes | Nursing Care for the Patient with a Chest Tube NCLEX Review


When caring for a patient with a chest tube,
there are several things that we have to keep in mind to be able to provide them the best
nursing care available. This presentation is going to cover those things that you need
to know to care for the patient and to know the right answers for NCLEX questions and
for, to answer questions in your class during your respiratory section. So, if you would
like to learn more about chest tubes, the best resource I can provide to you is going
to be the Atrium, Atrium website. Atrium is the provider of chest tubes that I have seen
most often in ICU. So, if you wanna learn more, go over to Atrium, they have pamphlets
and everything about different test tubes and different things that you need to know
to understand more complex things with the test tubes. This presentation is gonna allow
you to understand exactly what you need to know when caring for a patient and to pass
NCLEX questions. So, first of all, let s talk about the indication
for chest tubes. Primarily, we re gonna be giving test tubes to drain fluid, blood, or
air. So, some of the things that would require chest tube might be like a pneumothorax which
is a collapsed lung, hemothorax which will be blood on lung, a post operative chest drainage.
So, like after a thoracotomy. A thoracotomy is kind of scraping of the lung tissue to
make it easier for someone to breath, to get rid of that pain. Pleural effusion, which
will be fluid in lung. Lung Abcess. And then, just other post operative reasons that a patient
may need to get some of these fluid off of their, fluid or air, sometimes abdominal surgeries
or back surgeries can cause a little bit of a pneumothorax that would require relieving
that air. Other reasons would be to establish negative pressure or to re-establish negative
pressure. And then also, to facilitate chest expansion. So, for example, with like a pneumothorax
or something like that. Okay? So, let s look over here. Like I said, Atrium
is the brand that you re gonna see more often. So, this is the collection chamber here. So,
you can see you can go up all the way to 2,000 mL, and this tube here, is the tube that s
coming from the patient s chest. So, if you follow this cursor here, you can see there
s fluid being suctioned into the tube and then this is the collection port. And what
you wanna do is you wanna mark, like especially, as you can see there s actually a couple of
little marks here on this chest tube drainage system and you want to mark that in every
couple hours to be able to determine, you know, if there is drainage or how much drainage
there has been. This little line right here, this is your water seal. Okay? So, what s
gonna happen here is that the water seal is going to enable air to exit but not allow
it to enter. So, air exits can t enter. They ll be filled up to this 2 cm line. Okay. And
what s that gonna do is the patient inspires, no air is gonna be able to get in, okay? They
re gonna be breathing without entering air. But, as they expire, some air is going to
go, will be able to exit there. Okay, now, understanding that, we could understand, we
ll get into that a little bit later. And then, we can set our pressures here, and we can
also set up suctions as well. Okay. So, this are kinda the parts of a chest tube. This
is the Oasis model by Atrium. Okay. So, then obviously, there s this little flip-out thing
here, I d flip that out a little bit more, personally, but that is to help it to not
tip over. The chest tube needs to be upright and it needs to be below the patient s chest.
Okay? There s also little hangers here that can be hanged at the side of the bed for transport
or if you just wanna keep it off the ground. But generally, you just set it up at the foot
of the bed, with this out, needs to be upright, needs to be below the chest, kinda off the
foot of the bed, and you want to coil all the tubing up in the bed so there s no, there
s not a whole bunch of loops down here. Alright. So, that s the set up. Assessment. Tidaling. Okay, the first thing
to know is tidaling. Tidaling is a movement with respiration, it s a rise with inspiration,
and lower with expiration. That is okay. Okay. No tidaling would mean re-expansion or obstruction.
We don t wanna see continuous bubbling, but, this tidaling is okay. We wanna assess the
water seal level. Okay. We talked about that in this slide. We wanna assess this every
couple of hours. We need to have, this is filled with sterile water, okay. This is sterile
water, and that needs to be assess in every couple of hours. There s a port in back where
you can actually inject more water. So, if you run short of water, you can actually put
a little more in there and that needs to be assessed very closely. Output. So, this number
would vary based on experience and based on relationship with the surgeon, etc. But generally,
your report, if its greater than 70 – 100 mL every hour and then you ll assess the coloring.
If it s sanguinist, if it s pus-sy looking, if it s sanguinist, you know, you wanna report
that. And you ll just need to talk to the surgeon and understand what type of coloring
they are expecting. This is one thing that I see nurses kinda maybe fail to do, sometimes,
is to actually talk with the physician and understand their plan. It can be more difficult
maybe if you work at night. But if you do work at night, you can read the physician
s notes either in a computer or if there s some sort of a paper chart somewhere that
you can read or the post-op report to understand what they re looking for. Okay. You wanna
know what type of drainage and how much drain they are looking for, so that you re not freaking
out about something you should not freak out about and at the same time so you are freaking
out about what you should freak out about. Okay. So, this is just a little view of a
chest tube. Okay. This is the chest tube coming out of the patient, this is a nice little
occlusive dressing and then this would be going to the drainage system. Okay. So, that
is a chest tube would look like on a patient. Alright. That gives you a little view. Now, some of the nursing care. Like I said,
you re gonna coil the extra tubing in the bed, just kinda set up there, coil it, just
kinda have set it right there. Do not clamp the tube, you never gonna wanna clamp it unless
you have specific instructions to do it for a specific time and for specific reason. The
reason is, because if you clamp that tubing, you can actually create a tension pneumothorax.
Also, you never gonna strip the tubing. Strip or milk, people will call it milk. You re
not gonna strip that tubing, which means pulling, kind of dragging your fingers along it, trying
to get some of the fluids out. Never do that because that could, like I said, create that
high negative pressure within the lung and that can be detrimental to the patient. There
are a couple of things that you need to keep at the bed side, okay. You wanna keep hemostats
– 2 pairs, you wanna keep sterile water and a little syringe to insert more PD2, and you
wanna keep sterile occlusive dressing. I don t know if I spelled sterile wrong, I m not
sure, I don t remember. So, you wanna keep sterile occlusive dressing. Occlusive means
that, it s like, petroleum-coated, or something, so it s not going to allow air to get in or
out. Okay. So, those things you wanna keep at bedside for in case there s any sort of
complication. We ll get into that in just a second. Okay. Some of the complications that we can
have, these are the two that you need to know about, and I would spend my time studying
these and what you should do. So, some of the complications are going to be an air leak.
So, what you ll notice with an air leak is there will be continuous bubbling. Okay. That
little water seal chamber is just gonna be bubbling, bubbling, bubbling quite a bit.
I ve seen this happen several times and it s a very easy fix. What you ll do is you ll
take your 2 hemostats, that s gonna be 2 hemostats, and you re gonna clamp. This would be an instance
where you would need to clamp, trying to find out where the air leak actually is. So, you
would take your 2 hemostats, let s draw our patient here, here s our patient, okay, here
s the chest tube coming out, here s our drainage system. So, what you would do, you re noticing
continuous bubbling right down here, okay, in your actual water seal. So, what you ll
do is you take one hemostat, and clamp it right next to the patient s chest. You re
not doing this permanently, you re just doing this to assess. And then, you would clamp.
If you notice, if the bubbling stops, then there s a leak in the insertion site. Okay,
so if the bubbling stops there, there s a leak in the insertion site, okay? Then, what
you ll do is, you ll just gonna cross clamp and move your way down until you notice the
bubbling stop. So, you d put one hemostat here, one here. If the drainage, if the bubbling
stops, that means your leak is in this area. If the bubbling continues, you take one of
this, you take this hemostat, move it down here, if the bubbling continues, you continue
to do that all the way down until the bubbling stops. If the bubbling stops, that means you
found that your leak is within one of these areas, you identified it, and you tape it
with a very good tape and then you release this cross clamp and see if you can continue
the suctioning. Now, there are a lot of places that are tubings are connected and there s
a lot of places where there s possible to have a leak. So, you just wanna very closely
monitor this area here. The way you re gonna notice that an air leak is the continuous
bubble in there. If that happens, you need to address it quickly to make sure that the
patient is able to continue to drain as they need to. The other complication that you will
be tested on, on the NCLEX, absolutely, is going to be the removal. Okay. Let s say,
your patient is a little bit confused, they re sitting here in bed, they reached down
there, they ripped it out. Or, let s say, you re transporting the patient, this thing
falls down and it pulls it out. Okay, that s an emergency, okay, of course, and we want
to make sure that we fix it very quickly. So, what can happen is that the air can escape
very quickly and this can cause a tension pneumothorax as well. So, we want to address
that very quickly. The way that we re gonna address that is we re gonna slap a, so, let
s say, this is the patient s chest here, okay, and this is our chest tube insertion site,
and let s say our little friend here got a little anxious in the middle of the night
and they ripped the chest tube out. You walk in the room and it s sitting in their hand.
Okay, what you re gonna do, first of all, very first thing that you ll gonna do is throw
an occlusive dressing on the site. Now, you re only going to, and then you re gonna tape
it on 3 sides. Okay. Now, the reason you re only gonna tape it in 3 sides is you need
to allow air to escape during expiration to prevent that tension pneumothorax. Okay, so,
you want that leak, you want that air to still be able to get out as the patient expires.
Okay? So, you tape it on 3 sides, your occlusive dressing and you leave it open on 1 side to
allow air to escape in order to prevent the tension pneumothorax. That s the reason you
do that. Be sure you remember 3 sides. 3 sides, 3 sides, 3 sides, 3 sides. Always remember
that. That is required. Make sure that s what you re doing, alright? So, these are the things that you absolutely
must need to know for chest tubes in the NCLEX and for respiratory section. Be sure to visit
us at NursingStudentBooks.com where you can find all of our books, top rated Amazon books,
several books that are top 100 for all non-fiction books, and just about 15 different books available
for you to study. Also visit our blog at NRSNG.com where you ll find out about new books, some
of our study apps for NCLEX and all of our videos and podcasts and everything that are
up there. Make sure you check those two things out you guys, you can do this. Nursing school
is hard but you can do it. Thousands and thousands of nurses have done this before, we ve all
been through it before and we understand how hard it is. We re here to help. So, if you
want to reach out to me, you can reach me at [email protected] I m happy to hear from
you. I love hearing all your stories and everything. Also, be sure to subscribe, you can click
this little thing up here in the corner or you can click on my channel name down there
to subscribe and we d love to hear from you. Alright, thanks a lot guys. If you have any
questions, you can leave in the comment. Best place to do those too is to do it over on
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About Bill McCormick

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31 thoughts on “Chest Tubes | Nursing Care for the Patient with a Chest Tube NCLEX Review

  1. I really enjoy your lectures.
    I am now a respiratory Tx nurse and just love the simplicity of your lectures. It takes the stress out of nursing.
    xoxo

  2. Thank you so much! I've been listening to your podcast and purchased the 140 Meds book. Both resources have helped me tremendously and I am gliding through MedSurg now.

  3. best nrsing video ive seen even better than more famous youtube nurses thanks for making thing easily understandable

  4. i haven't remember listening to a discussion as comprehensive as this presentation. tysm nrsg.com team. You're all appreciated!😘

  5. I just want to point out in the opening section of indications for a chest tube, some the information presented was inaccurate.

    *A Thoracotomy is not a "scraping of the lung tissue" for reasons of: "to make it easier for someone to breath and get rid of pain." A thoracotomy it is the surgical incision into the chest wall. For example it is performed to gain entrance into the chest wall cavity to perform a lobectomy for tumor resection. The closest procedure I know of that can perform "scraping of the lung tissue" for reasons of: "to make it easier for someone to breath and get rid of pain" would be a bronchoscopy. Bronchoscopy is an endoscopic procedure, which can alleviate mucous plugging, and lung tissue biopsy- however it is important to point out as well, that this procedure rarely results in the need for a chest tube placement.

    *The speaker also said that a pleural effusion is "fluid in the lung." This also is incorrect. An pleural effusion is an abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption or both- the pleural space is the space that exists between the two layers of the pleura (the thin covering that protects and cushions the lungs) between the lungs and chest cavity. The pleural space is normally filled with a small amount of fluid. The correct term would be pulmonary edema; pulmonary edema is the fluid accumulation in the tissue and airspaces of the lung. Pulmonary edema would never be an indication for a chest tube. Pleural effusions also are rarely an indication for a chest tube, they can often be drained via a procedure known as a thoracentesis.

  6. Please always refer to the at the Atrium website. You should never tape a flutter valve on a patient in the hosptal. This guy is dangerous.

  7. I love it.. thanks for the illustrations.. in that way.. I don't have to use my imaginations since I haven't seen that in actual setting. thanks.. you have just gained a subscriber

  8. John, we didn't see one chest tube in my clinicals and I re-listened to my lecture tapes. We didn't even cover nursing care of a chest tube.   God, thank you so much for this video.

  9. I've seen many vedio of chest tube setup and trouble shooting and what to be expected and what not to be expected, but none of the vedio gave a detail route from the point where the drainage comes out from the chest to the suction connection…How each one of these elements of this system connected and sffect each other? If I know that,it'll much easier to understand why certain chamber is expected to see bubbles while other chambers are not. Just "remember" does not work well. I can remember, but I don't understand.

  10. Your calm voice really reminds me to stay calm and study on! Even when saying MUST KNOW… you are calm. Keep your presentations that way.!

  11. In my text book they said not to clamp, because that can lead to tension pneumothorax that can lead to cardiac arrest of the patient.

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