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Discussion

Help with Chest Tubes Please!!!

Hello...we're studying chest tubes right now and I'm answering some questions but can't seem to figure one out! Chest tubes are a bit confusing when all you have available are a few pages in the book and a couple of videos...

Anyhow, the question that was asked was: "The MD orders 'Discontinue suction and maintain patient to underwater seal' ...describe how you will accomplish this"

I have no clue.....any help/suggestions is always appreciated!!!

Thank you!!!!!! :bowingpur

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This is the manufacturer website and there is an excellent Power Point on chest tubes from A to Z. Just click on the "education" tab on the left of the page and you'll learn everything you need to know about chest tubes.

http://www.atriummed.com/Products/Chest_Drains/ocean.asp

This is one of the things it was easier for me to see in action than to learn about in lecture. Basically, there is a passive water seal suction in the actual drainage system itself. Additionally, the system can be hooked up to wall suction. So when the doc wants just water seal drainage, it means you can take off the wall suction tube. In the picture below, there are two tubes. One goes from the patient to the drainage, the other goes from the drainage to the wall suction (it's the one that is on the floor in the picture below. The wall suction is not shown in this picture.) Hope that helps.

ChestTubeSystem2.jpg

The ones i have dealt with have been attached to wall suction (using adifferent adaptor than the normal suction unit). This draws out the air/fluid whatever theyre trying to get rid of. The step down is the underwater seal. It is shown in the picture above. You will hear and see it bubbling away as the pneumothorax decreases. Its underwater so nothing else can get back into the space your clearing out. As the patient progresses the noise will decrease. Its important to always kep the tubes and collector above waist height and standing upright and sealed. It is important to never clamp the tubes but to have two clamps attached to the unit for emergencies. Also important to educate patient of these. Pain management. coughing and deep breathing exercises. Monitor the collector for bubbling, oscillating, drainage, type, colour consistency of drainage, pain level, and drain insertion site. Hope that helps

  • Expert

there are chest tube related weblinks that are listed on post #13 of this sticky thread: https://allnurses.com/nursing-student-assistance/any-good-iv-127657.html - any good iv therapy or nursing procedure web sites

"the md orders 'discontinue suction and maintain patient to underwater seal' ...describe how you will accomplish this"

the answer is to just shut off the suction. that is all. you leave all the other tubes connected. all the suction was doing was providing some extra external pull.

the chest tube is designed to help maintain smooth the operation of the lungs while a hole(s) in the pleura heal over. the water seal prevents outside air from entering into the pleural space (where it doesn't belong) every time the patient takes an inspiration. when the patient expires, the water seal allows any air and secretions trapped in the pleural space to exit through the chest tube. all the suction does is apply an external pull during expirations to help pull drainage out of the patient's pleural space.

this is my rationale on the lungs, lung injuries and chest tubes: there should be only one hole through which we breathe air (the windpipe). if there are any other holes in the lungs a chest tube is used to take control of them and deal with the situation. chest tubes drain air, blood and gunk (pus) from the lungs--think of them as support (kind of like a
crutch
) so the lungs can carry on their normal function of inspiration and expiration. breathing in and breathing out will stop when the lungs become overwhelmed with air, blood and/or gunk. or, the heart stops beating.

i have to tell you my chest tube story. we didn't learn a whole lot about them in school. wouldn't you know i ended up some years later working on a stepdown unit where we had a chest surgeon who did a lot of cardiothoracic surgery. whenever these guys crack a chest, a chest tube goes in when they close up. this doc was famous for making rounds with nurses and asking questions about how to troubleshoot problems with his chest tubes. he didn't like being called at all hours of the night when problems with them arose. he got nasty if nurses didn't know the answers. his rationale was that if nurses are working with patients with these tubes they ought to know what they are doing, shouldn't they? anyway, for a while i worried about running into him. then, as i usually do, i realized that i needed to learn about working with these tubes because i found myself dreading getting one of his patients when they transferred over from the icu. i went over to the medical library of one of the local medical schools and spent a morning looking for and pulling the few nursing journal articles i could find on chest tube care. this was back in the 1980's. i found one really good article from an ajn, i believe, from the 1970s that was referenced in every article i was reading and xeroxed it. it took me a few days and reading this information several times to finally "get it". i started volunteering to be assigned to the chest tube patients just to be able to study these things and get experience. do you know that my co-workers were more than happy to oblige? what was with that? made me think that i probably wasn't the only one who didn't understand what was going on with chest tubes. anyway, a few months later a ceu (continuing education units) offering was advertised for the icu nurses on chest tubes! i couldn't believe this. i went to this 4 hour offering and it really was icing on the cake for me. it was an offering by a outside nurse practitioner and she brought all kinds of different drainage containers that can be attached to the tubes. it was a chance to finally ask someone questions. just one little invention--the one way flutter valve--changed chest tube mechanics and outdated the use of the old bottles of water that we were still using back in the 1980s. i waited and waited for this doc to grill me, but he never did.

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