You are Observing your client's chest tube and you notice that the fluid is no longer fluctuating in the tube. Discuss 3 possible reasons and the nursing actions required.
-the lungs are re-expanded
-the tube may have an obstruction
-a loop of tubing hangs below the rest of the tubing
-suction motor or wall suction is not working properly
Discuss "milking" and "stripping" the chest tube. Discuss why this is no longer routinely done.
Can cause a tension pneumothorax. Only do if is ordered to do so.
Discuss how you would assess for an air leak.
Start at the client. Clamp with special padded clamps BRIEFLY. If air leak is still there, continue until you find the leak, or until you reach the drainage unit. If it is the Drainage unit, replace it.
Discuss clamping the chest tube. When should the chest tube be clamped?
When it is Clamped, It should only be clamped BRIEFLY, and with a special padded clamp. It can be clamped for changing drainage units, to check fo leaks, and sometimes the primary care provider may request it to be clamped to assess if the tube is ready to be removed.
Discuss what will happen if you lift the client's collection chamber above the chest level.
The drained fluids may reenter the body and cause an infection.
Your client has -20 cm of water in the suction control chamber. The wall suction unit is accidently turned up to 100 mmHg (high). Will this cause a problem?
No, the water controls the negative pressure going to the pleural space. The only issue it may cause is the water in the chamber my evaporate faster.
How would you determine if it was time for the client’s chest tube to come out? How would you assist the physician?
Discuss positioning and C&DB with the chest tube client.
You notice there is excessive bubbling in the suctioning control chamber. What is your nursing action?
What do you do if the chest tube falls out of the chest?
You should cover with a dry sterile pad and tape only 2 or 3 sides. Call Primary Care Provider immediately.
What do you do if the chest tube becomes disconnected from the tubing?
Place tube that is connected to the client in a bottle of sterlile water, replace tubing if needed because of contamination. Assess Client. Contact Primary Care Provider if tube needs to be replaced.