Chest tubes

cardiacnurse05 · May 9, 2006

The answer is D.

A patient can go to x-ray as long as the chest tube is hooked to suctioning.

You should never clamp the chest tube (unless changing the drainage container or when anticipating pulling it when the pneumo has essentially resolved) and you should never remove the pleural vac . The first answer is kinda tricky because you can have a chest tube that is not hooked to suction. But NOT ALWAYS can you leave a patient off of suction so that is why that answer would be ruled out.

tdg_rn · May 9, 2006

Is this a nursing school question? I can't remember the nursing school answer but based on experience it is [D]. Suction is there to help remedy a pressure problem in the lung space (i.e. - pneumothorax). Once it is in place it should generally remain until it is determine the problem and/or it's cause has been corrected.

[A] is also a possiblity depending on the doctor's order. I have had to do it but I think that it is a rarer or less correct answer for nursing school purposes.

would be wrong because the patient can be transported d/t one of the above solutions. (D or A)

[C] would be wrong because clamping a chest tube is supposed to require a nurse with additional training or an MD. (- at least in my state.)

hrtprncss · May 9, 2006

i think it's A, actually you put it on water seal and send them down so it's A, maintain pleurvac, if maintaining pleur vac means put on water seal. When you walk patients that are open heart and have chest tubes you just disconnect them from suction and maintain water seal while they're walking. This is the same when you send people down to CT or MRI or even CXR. Portable suction is heavy and can only accomodate 1 ct, and there are patients with multiple chest tubes, so all you have to do is take off the suction and return back when ready.

edit: but tdrn said it's a nursing school question, so practice and theory can be different sometimes lol

snowfreeze, BSN, RN · May 9, 2006

e) clarify with doctor prior to putting to waterseal and if not an option, order a portable x-ray

Lisa CCU RN, RN · May 9, 2006

This is a question from my nurse extern guide. I had 50 questions and either knew the answer to them or found it in the book, but this one doesn't seem to be in there or maybe I'm just overlooking it.

I'd guess you'd say that this is an actual practice answer.

Lisa CCU RN, RN · May 9, 2006

e) clarify with doctor prior to putting to waterseal and if not an option, order a portable x-ray

LOL. There's no E.

Maybe if someone could explain exactly what a chest tube does and how it works, I'd be able to figure this out on my own.

I know you'd use it to drain after surgery or if there was pneumothorax, but I have had no real experience with them.

Tweety, BSN, RN · May 9, 2006

I would think the text book answer would be B, the only problem with that answer is that it is not true that they never can go to the department.

Very often the doc orders AP and Lateral chest xrays and these can't be done portable so the CT is removed from suction and the plueravac maintained, so the answer here is A.

Where I work the order for the AP later is taken as an order to disconnect them from suction long enough to do the xray. Usually for the first few days the MD orders portable and then wants to check it off suction and orders the AP lateral. When in doubt however, we always do portables or call the doc for orders to take off of suction.

I've never seen anyone go to xray with a portable suction, but that' only my experience at one hospital.

Never clamp a chest tube without an order.

gauge14iv, MSN, APRN, NP · May 9, 2006

In real life - the patient gets a portable x-ray. Portable suction is not always availble, reliable or functional, you dont want to move a pleurivac unit any more than you absolutely have to because you risk tipping it over etc. In fact- we always taped the stand of the unit to the floor so it couldnt be moved. Much easier to just roll the portable x-ray unit to the patients room!!

weirdRN, RN · May 9, 2006

LOL. There's no E.
Maybe if someone could explain exactly what a chest tube does and how it works, I'd be able to figure this out on my own.
I know you'd use it to drain after surgery or if there was pneumothorax, but I have had no real experience with them.

A chest tube is an extension of the pleural space. Chest tubes are usually used for draining air or fluid from between the visceral and parietal pleura of the lungs to allow for maximum lung expansion. The water seal keeps air from entering the pleural space on exhalation. Suction keeps negative pressure on that space to help remove fluid, pus, and facilitate max lung expansion

Chest tubes should NEVER be clamped unless by a dr's order and only under close supervision as that may cause lung collapse and cause a mediastianal shift.

Lisa CCU RN, RN · May 9, 2006

A chest tube is an extension of the pleural space. Chest tubes are usually used for draining air or fluid from between the visceral and parietal pleura of the lungs to allow for maximum lung expansion. The water seal keeps air from entering the pleural space on exhalation. Suction keeps negative pressure on that space to help remove fluid, pus, and facilitate max lung expansion
Chest tubes should NEVER be clamped unless by a dr's order and only under close supervision as that may cause lung collapse and cause a mediastianal shift.

So, according to what you've written, I would think you'd never want to remove the suction unless the MD ok'ed it. Now I'm leaning towards A or D.

I'm still trying to read my guide for the answer.

HappyNurse2005, RN · May 9, 2006

Depends on the pt and the MD. I'm in a cardiac surgery pcu, with many cardiac and esp thoracic surgery pt's who have chest tubes, and more often then not, its to put on waterseal, then put back on wall suction when arrived back in room.