Chest tube question????

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HI everyone,

Last night I had a patient with a small pneumothorax...she had a chest tube set up to 20cm suction. The thing worked great all night for me...absolutely no bubbling of the water seal chamber. Well...this am....x-ray came to get her for a chest x-ray. The doc. wrote an order that the suction could be d/c'd for x-ray. I dis-connected the suction and the pt. went down. When she came back, I re-hooked the suction up...and magically.....my water seal chamber was bubbling....pretty strongly at that. Well....when I would turn off the suction completely...the seal chamber wouldn't bubble....... My question is...what is going on with that???? Is there a leak due to the patient...or is it something goofy with the suction. All connections were checked too. I felt so bad....of course it happened at the end of my shift..so it was one of those pass it on things. I just hope something didn't get screwed up...I'm feeling really badly about the whole thing now. We don't get chest tube patients very often...and I guess I forget all the mechanics of them....someone ...please help????

Thanks so much :kiss

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a little late now, but did you check the measurement on the chest tube to see if it had dislodged any? Since your air leak is new, presumably one would think something happen on the trip to x-ray. But that's not your fault really. Also, some chest tubes give off an air leak no matter what, and our surgeons tend to go by the xray rather than a persistent air leak. I'm not saying this was the case in your situation because your air leak was new, but my guess is that your chest tube got moved some how. Did you check the position on xray? It's also possible that you had a leak in your tubing. Maybe something got hit on the way to xray. Did you clamp your tubing to look for air leaks? Just a couple regular troubleshooting methods that we use. Hope it all works out well.

It could also be possible that the patient had another pneumo. Not likely, but not unheard of. What was the patient in for?

David

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Thanks David....

You hit the nail on the head. I was thinking about this thing all day...so I decided to call the pm staff and ask about the patient. Apparently...the tube did become dislodged while the patient was in x-ray.??? Luckily...the pneumo. had resolved itself and they didn't have to put another one in....thank goodness!!!! I still feel that I should have called the doc....but it was one of those....I'm on the way out the door things....I did chart it and tell the charge nurse and the nurse assigned to that patient. Apparently the doc. wasn't mad...so that's good. By the way...the patient was in for pleural effusion....had a thoracentesis...and the lung was punctured by accident during the procedure....so it was kind of that doc's fault anyways....not that I'm blaming him...unfortunately..that's one of the risks of thoracentesis. Anyways...I feel a lot better now , knowing that my patient is ok and didn't need the tube re-placed. Thanks for all your help...much appreciated.:kiss

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My concern would be how long the patient would have been in her room before the next shift was through in report and actually assessed her and called the doctor. Chest tubes are tricky little devils.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Great info on chest tubes here:

http://www.icufaqs.org

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Specializes in ICU.

I love that site!!! I look up stuff there all the time!

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