Pneumothorax/Chest tubes

Symptoms of pneumo

o Depend on size and cause

o Pain-sudden, pleuritic

o Minimal respiratory distress to severe hypoxemia

o Tracheal deviation to the unaffected side (only with tension pneumothorax)

o Hypotension

o Tachycardia

o Profuse diaphoresis

o Central Cyanosis

o Subcutaneous Emphysema (also called crepitus)

Complications of pneumo--> Open Pneumo

§ Can be from an opening through the chest wall

§ Sucking chest wound

Complications of pneumo--> Tension Pneumo

§ Can happen from a laceration of the lung itself or from trauma

§ Air becomes trapped and cannot escape

§ Collapses the lung and pushes on the trachea

Complications of chest tubes--> Chest Tube Drainage System Breaks

o Immerse the end of the chest tube in sterile water to restore the water seal.

Complications of chest tubes--> Chest Tube Accidently Removed-

o Occlusive dressing is taped on only three sides and placed on the insertion site. This allows for air to escape and reduces the risk of tension pneumothorax

Complications of chest tubes--> Tubing Separates-

o Client exhales as much as possible, nurse cleanses the tip and reconnects the tubing.

Normal assessments of the CT drainage system-- Drainage Collection Chamber

§ Drainage collects in calibrated columns

§ Amount is marked (not emptied) in a closed system

Normal assessments of the CT drainage system-- Water Seal Chamber

§ Water level fluctuates (tidaling):

· Rises with inhalation

· Falls with exhalation

§ No continuous bubbling

§ Intermittent bubbling is normal ONLY with the first inserted for pneumothorax

Normal assessments of the CT drainage system-- Suction Control Chamber

§ Gentle bubbling is normal (indicates suction is working)

Normal assessments of the CT drainage system-- System Setup

§ Drainage system kept below chest level

§ System remains closed and sterile

§ The chest tube is sutured in place

Abnormal assessments of CT drainage system-- Water Seal Chamber

§ Continuous bubbling → Air leak (NOT normal)

§ No fluctuation (tidaling) → possible kink or lung re-expansion

Abnormal assessments of CT drainage system-- Suction Control Chamber

§ Vigorous/large bubbling → TOO much suction (bad)

Abnormal assessments of CT drainage system--Drainage Concerns

§ Output > 70-100 mL/hr

§ Sudden increase in drainage

§ Drainage becomes bright red

Abnormal assessments of CT drainage system-- Insertion Site

§ Redness, swelling, pain → possible infection

§ Crepitus (subcutaneous emphysema)

Abnormal assessments of CT drainage system-- System Issues

§ Dependent loops in tubing

§ Loose or disconnected tubing

§ Drainage system above chest level

Care of the patient with a chest tube--   Monitoring & Assessment

§ Check the insertion site for:

· Infection

· Pain

· Crepitus

§ Assess vital signs & respiratory status every 4 hours

§ Document drainage amount & color every 8 hours

Care of the patient with a chest tube--Positioning & Mobility

§ Reposition frequently to promote drainage

§ Encourage coughing & deep breathing

Care of the patient with a chest tube--System Maintenance  

§ Keep the system below chest level

§ Ensure all connections are taped

§ Avoid dependent loops

Care of the patient with a chest tube-- Safety Precautions

§ Do NOT clamp unless ordered

§ Do NOT strip or milk unless ordered & policy allows

§ Keep at bedside:

· 2 padded clamps (hemostats)

· Sterile water

· Occlusive dressing

§ Pain Management

· Administer prescribed pain medications

§ Dressing Care

· Maintain an occlusive sterile dressing

Change per facility policy

Sub-Q emphysema

o Aka crepitus

o Monitor chest tube insertion site for redness, pain, infection, crepitus (subcutaneous emphysema) & an occlusive dressing

o Clinical manifestation of pneumothorax