chest tube assessments

[Studentpn1]

I am presenting a power point in a few days to my classmates on chest tubes. One area of topic is assessments. I know what to assess the chest tube chamber for, but what if a nurse walked into the patients room and the chest tube was out or not working, what would be the best thing to do and what proceeds that until the patient has the chest tube in again? Also if you have anything to add related to chest tubes that you feel is important for students to know, please comment! Any help will be greatly appreciated!

[icuRNmaggie, BSN, RN]

If the CT is placed for pneumothorax,

If you hear whistling of air at the insertion site, it's out. Assess the pt for resp distress and tracheal deviation. Notify the surgeon as he needs to come in an replace it and ask if he wants an XR now. Do not push it back in as it is no longer sterile. (Prepare for CT insertion with a new drainage system.

CXRs should be done on expiration, not inspiration which can obscure a pneumothorax. ( Can you explain why? )

If the CT is totally out, apply a telfa dressing. Assess for resp. distress. This situation justifies calling a rapid response if there is no MD available to manage the pt.

If you ever observe anything unusual about the drainage, which should be minimal in a PTX, if it looks like the coffee they had for breakfast in a trauma pt, that person has a ruptured esophagus and that is a surgical emergency which must happen in under 24 hours. A CT must be done. This pt belongs in a trauma center. The esophagus can not be repaired once infection sets in.

If the CT is placed for hemothorax, as in a trauma pt who is anticoagulated and fell sustaining a flail chest,

monitor hourly CT output. Blood loss greater than 100cc per hour must be reported.

Expect the pt to need FFP, Vit K, PRBCs. Leaking of blood around the tube is not unusual,

reinforce the dressing and get an order to change it if saturated.

Vaseline gauze should be wrapped around the tube at the insertion site.

A splint made out of a bath blanket helps the pt to take deep breaths and is a comfort measure.

Vigorous coughing can stimulate more bleeding, and should be avoided until the pt is stable.

[Studentpn1]

Thank you icuRNmaggie! Very helpful response.

[littlemissbookworm]

Emphasize to assess from patient to chest tube or chest tube to patient. I would look up subcutaneous emphysema. That's a complication that you can get. Also, pain management is important in these patients. We want them deep breathing, coughing, using an incentive spirometer, and mobilizing. If the patient is in pain, he/she will take shallow breaths, won't cough to clear secretions, etc.