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There you are, getting report on your clinical assignment, and you see that your patient has a chest tube. OH NO! Suddenly, a crowd of thoughts enter your head. What if it becomes dislodged? What if it tips over? What if it stops working? What if it gets clogged? What if, what if, what if. First of all, good for you for even THINKING that chest tubes might be serious business…because they most certainly are. But with a little bit of guidance, you’ll walk into your patient’s room with confidence and maybe say, “What if I totally rock this clinical day?” Let’s make sure you do. What is a chest tube?A chest tube is essentially a device used to drain air or fluid from the pleural space in order to restore the lungs to normal function. The PleurEvac is a commonly used chest tube system which contains three chambers: 1) the collection chamber; 2) the water seal chamber; and 3) the suction control chamber. How does a three-chamber system work?Understanding how chest tubes work goes a long way toward making them less scary. When you know what you’re looking at, you’ll be more adept at troubleshooting and less likely to panic when something goes wrong.
Because there are a variety of types and brands of chest tube drainage systems, we won’t go over the specifics of each one…this is one of those things that is much easier to learn if you can actually touch the product with your own hands. This is the type we use, if you want to check it out! When is a chest tube used?A chest tube is used in a variety of situations, but mainly falls into a few categories:
How do I manage a chest tube?If your patient has a chest tube, your job is to make sure it is functioning properly at all times. Sounds simple enough, right? Here are some basics you’ll want to implement with every single chest tube patient, every single time:
I’ve got an air leak. Where is it coming from?Excellent question! Remember those clamps you got from central supply so you’d have them at the bedside at all times in case of an emergency? Well, grab one of those…and with your RN standing by (and ensuring you are covered by hospital policy or an MD order), you’re going to clamp the tubing at the insertion site and assess the air leak. If it STOPS when you clamp it, then the leak is coming from inside the patient. If it DOES NOT stop, then the leak is coming from elsewhere in the system. To check if it’s coming from the system, you’ll progressively clamp the tubing at 8-12″ intervals all the way back to the collection device and note where the leak is occurring. You’ll notice that the air leak stops when you clamp between the location of the leak and the water seal. If the leak is coming from your tubing or collection device, then the fix is as easy as getting a replacement. You’ll also want to check all your connections at this point…make sure they’re taped together securely, that there are no tears or holes in your tubing and that the tubing is connected securely to the collection device. BE SURE TO WATCH YOUR PATIENT WHILE YOU ARE CLAMPING THE TUBING! If he shows signs of respiratory or hemodynamic compromise…stop and alert the MD. Note that clamping the system to check for air leak is something that varies by facility. Always check your facility’s policy as you may need an MD order to do this form of troubleshooting. What if the leak is coming from the patient? In a pneumothorax, you’re going to have an air leak coming from the patient…because there is air IN the patient and we want it OUT! So, you’ll want to watch this to see if it gets better or worse. The chest tube systems we use have a numbered chamber ranging from 1-7. An air leak present at level 1 is mild, whereas a leak at level 7 is severe. Over time, your patient’s air leak should improve as their pneumothorax improves. If it doesn’t, then that’s a conversation for you and the doc to have (remember to use your SBAR!). Another consideration is that the air leak could be coming from the system, very close to the patient, underneath the dressing. So…if you think the leak is coming from the insertion site, you’ll need to take down the dressing and look at the tubing. If the eyelets are outside the chest wall, alert the MD. If you can’t see any obvious signs that the leak is coming from the insertion site or the tubing at the insertion site, then it’s likely coming from the lung. Replace the dressing and carry on.Now, what about all those “what if scenarios?”I always say that if you know what to do in an emergency, it probably won’t happen (knock on wood). And if it does happen, you’ll know how to deal with it without an undue measure of panic.
And before we call it a day, one question that comes up ALL THE TIME, is if the chest tube should be clamped if you are transporting the patient from one area to the other (for example, to go to CT scan). I think you know the answer to this…but just in case, it’s NO! Be safe out there and, as always, please defer to your facility’s polices and procedures where differences exist 🙂 facebook linkedin twitter pinterest
Being a successful nursing student is more than just study tips and test strategies. It’s a way of life.
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