Chest tube help

[lrc1203]

I start critical care clinical in a month and the instructor said we should already know about chest tubes and what to look for in the drainage collection device. I feel like we were never taught on this. What exactly am I looking for? I'm assuming a certain color and amount??

[Mike R, ADN, BSN, RN]

Color, amount of drainage and adequate water. Rise and fall with inspiration and expiration. But also look for bubbles if it's on suction. No bubbles = leak. Do the pinch test to find the leak source if you suspect one.

[That Guy, BSN, RN, EMT-B]

Also please dont forget to assess the pt! Look at the insertion site for REEDA and crepitus or however the heck it is spelled.

[turnforthenurse, MSN, NP]

Color, amount of drainage and adequate water. Rise and fall with inspiration and expiration. But also look for bubbles if it's on suction. No bubbles = leak. Do the pinch test to find the leak source if you suspect one.

a "roaring bubble" can also indicate a leak...the bubbling should be gentle.

chest tubes are indicated for pneumothorax, hemothorax, empyema, pleural effusion and recovery from thoracic surgery. they can be pleural or mediastinal (generally indicated for cardiac tamponade or open heart surgery). chest tubes help restore negative pressure in the pleural space.

complications:

- infection

- pneumothorax (especially tension pneumothorax!)

- hemorrhage

if you see no fluctuation (called "tidaling") in the water level as the patient inhales/exhales, it could mean the tubing is kinked OR could mean that the lung has inflated and is healed. it generally takes ~3 days for healing to occur.

if there is bubbling when inhaling, that also indicates a leak.

when looking for leaks, start AT THE PATIENT, then make your way down the tube towards the collection box. check all connections (usually the connections just need to be taped)...but if you can't locate the leak, the collection box (Pleuravac, Atrium...might be called something else but those are the only two names I know) unit will need to be changed.

for drainage, up to 100cc/hr for adults (and up to 30cc/hr for kids) is okay...any more and you want to notify the physician.

note drainage every hour.

taping the Pleuravac/Atrium to either an IV pole or to the floor to help prevent it from knocking it over by accident...if you do that, you can displace the drainage in the collection chamber and then your outputs might not be accurate.

never clamp the chest tube...this can lead to a tension pneumothorax (pressure builds up inside the pleural space and can cause what is called a "mediastinal shift" - everything starts shifting to the side. you may notice tracheal deviation (it's no longer mid-line). tension pneumothorax is an emergency and can kill the patient if there is too much pressure (compresses the heart and great vessels = no cardiac output!). you may however need to clamp the tube to locate air leaks. you should never clamp the tube for more than 10 seconds and you should use padded hemostats (either hemostats with a thick plastic covering on the ends OR you can also use washcloths - fold them up, place them on the tube and then clamp).

you also want to assess the insertion site...look at the amount and characteristics of the drainage and also palpate around the area to assess for subcutaneous emphysema (feels like rice krispies under the skin). This also indicates a leak.

these supplies should be kept at the bedside when you have a patient with a chest tube:

petrolatum gauze

padded hemostats

sterile water in which to submerge the CT if it becomes disconnected from the underwater seal system.

[lrc1203]

thank you