Introduction to Chest Tubes and Drainage Systems – Week 7 HLTH 408

A comprehensive set of question-and-answer flashcards covering thoracic anatomy, pleural physiology, indications, contraindications, complications, chest-tube mechanics, and emergency management from the Week 7 HLTH 408 lecture on chest tubes and drainage systems.

What three bony structures form the semi-rigid chest wall?

Ribs, sternum, and thoracic vertebrae.

What muscle forms the lower boundary (floor) of the thoracic cavity?

The diaphragm.

Into what three major areas is the thoracic cavity internally divided?

Mediastinum, right lung compartment, and left lung compartment.

Name the four parts of the mediastinum.

Superior, anterior, middle, and posterior mediastinum.

Which structures are found in the superior mediastinum?

Thymus, trachea, esophagus, and many arteries and veins.

Which major organ and its protective sheath occupy the middle mediastinum?

The heart and the pericardium.

What membrane lines the inside of the rib cage?

Parietal pleura.

What membrane covers the surface of the lungs?

Visceral pleura.

How much lubricating fluid normally remains in the pleural space at any time?

Approximately 10–20 mL.

What natural tendency of the lungs is counteracted by the pleural space?

The elastic tendency of the lungs to collapse or recoil.

Why is the pleural space called a “potential” space?

Because it can hold a large amount of fluid if it accumulates.

Define intrapleural space.

The potential space between visceral and parietal pleura containing ~4 mL of fluid.

During normal inspiration, how does air enter the lungs?

Chest expansion lowers intrapulmonary pressure below atmospheric, pulling air in.

What holds the visceral and parietal pleurae together during breathing?

Surface tension of pleural fluid.

During normal expiration, what main forces cause air to leave the lungs?

Relaxation of chest wall muscles and elastic recoil of the lungs.

List six common indications for inserting a chest tube.

Spontaneous, open, closed, or tension pneumothorax; hemothorax; pleural effusion.

What demographic is most at risk for primary spontaneous pneumothorax?

Young, tall, thin men who recently had a growth spurt.

Give two examples of injuries that can cause an open pneumothorax.

Stabbing and gunshot wounds (also fractured ribs or thoracic surgery).

What happens to intrapleural pressure in a closed pneumothorax?

Loss of negative pressure due to air escaping from injured lung into pleural space.

Why is tension pneumothorax a medical emergency?

Air enters pleural space and cannot escape, raising pressure, shifting mediastinum, and impairing circulation and ventilation.

How does tension pneumothorax reduce cardiac output?

Compression of the vena cava decreases venous return to the heart.

Name four classic signs or symptoms of pneumothorax.

Increased respiratory rate/dyspnea, pleuritic chest pain, diminished breath sounds, tracheal deviation (away from affected side).

What is subcutaneous emphysema and when might you feel it?

Crackling sensation under skin due to air in subcutaneous tissues, often present with pneumothorax.

What defines a hemothorax?

Collection of blood in the pleural space.

Why does a hemothorax cause lung collapse?

Blood disrupts negative intrapleural pressure, allowing lung recoil.

Differentiate transudative and exudative pleural effusions.

Transudative fluid is protein-poor (e.g., heart failure); exudative is protein-rich (e.g., pneumonia, cancer).

What rare pleural condition results from thoracic duct damage?

Chylothorax (chyle leakage into pleural space).

Are there absolute contraindications to chest tube insertion?

No definite contraindications, especially in respiratory distress; risks vs. benefits must be weighed.

How is the size of a pneumothorax used to decide on chest-tube placement?

Small may be observed; medium/large or tension pneumothorax require chest tube.

List four common risks or complications of chest tubes.

Bleeding, infection (empyema), subcutaneous emphysema, malposition (most common).

What is re-expansion pulmonary edema and give one clinical sign.

Edema occurring after rapid lung re-inflation; signs include sudden shoulder pain, coughing, SpO2 drop, or respiratory distress.

State the primary purpose of a chest tube.

To remove air or fluid, restore negative intrapleural pressure, and allow lung re-expansion.

How long is a typical chest tube and how many drainage eyelets does it have?

About 50 cm long with four to six eyelets on the distal end.

Why does a chest tube have a radiopaque line?

To make its position visible on chest radiograph and identify the most proximal eyelet.

List the three primary objectives of chest tube therapy.

Remove air/fluid promptly, prevent their return, and restore negative pressure to re-expand the lung.

What is “tidaling” in a water-seal chamber?

Normal rise and fall of water with the patient’s respiration indicating patency.

During spontaneous breathing, how does water move in tidaling?

Water level rises on inspiration and falls on expiration.

What does absence of tidaling suggest?

Possible tubing kink/obstruction or complete lung re-expansion.

What does intermittent bubbling in the water-seal chamber indicate?

Air leak from the pleural space (expected early in pneumothorax).

If continuous bubbling persists after clamping near the insertion site, where is the leak likely located?

In the drainage system (CDU) rather than in the patient or tubing.

What immediate steps should you take if a chest tube disconnects from the drainage system?

Notify physician, assess patient, unclamp tube, cleanse ends, reconnect, secure, and temporarily clamp near insertion while patient exhales.

How should you manage an accidental chest-tube removal from the patient?

Seal with sterile petroleum gauze, tape with occlusive dressing, notify physician, and assess for distress.

Why should chest tubes not be routinely clamped?

It can cause tension pneumothorax by trapping air.

Name three emergency supplies that must remain at the bedside of a chest-tube patient.

Two clamps, bottle of sterile water/normal saline, and petroleum gauze.

Why should aggressive stripping or milking of a chest tube be avoided?

It can create extreme negative pressures without significantly improving patency.

When assessing the water-seal chamber, what does bubbling without tidaling suggest?

A connection leak in the system; secure all connections.

What feature of an ATRIUM or THORASEAL drainage unit replaces water with a one-way valve?

A dry suction or mechanical one-way valve system.

What volume range of fluid crosses the pleural space each day under normal conditions?

One to two liters, with only 10–20 mL remaining at any moment.

Which patients on ventilation are at higher risk for tension pneumothorax and why?

Patients receiving positive-pressure ventilation, because air is pushed into the chest under pressure each breath.