NCLEX Review: Chest Tubes

Presenter

• Sarah from RegisteredNurseRN.com

Overview

• Focus on the essentials for NCLEX exam
• Topics: Anatomy, Drainage Systems, Purposes, Nursing Interventions

Purpose of Chest Tubes

• Definition: Tube inserted into pleura space to remove air/fluid, aiding lung re-expansion.
• Anatomy:
  • Visceral Pleura: Protective layer around lung
  • Parietal Pleura: Attached to thoracic cavity
  • Pleura Space: Contains serous fluid, allows layers to glide, maintains negative pressure
• Function: Drains air/fluid disrupting lung pressure

Types of Chest Tubes

• Mediastinal Tube: Drains fluid from around heart post-cardiac surgery

Indications for Chest Tubes

• Pneumothorax: Air in pleura space, causes lung collapse
  • Causes: Trauma, spontaneous
• Pleura Effusion: Fluid in pleura space
  • Types:
    • Hemothorax: Blood in pleura space
    • Empyema: Infection in pleura space
    • Chylothorax: Lymphatic fluid in pleura space
• Cardiac Surgery

Chest Tube Drainage Systems

• Importance: Familiarize with types used at facilities
• Basic Setup:
  • Drainage Chamber: Collects drainage from lung
  • Water Seal Chamber: Monitors air leaks
  • Suction Control Chamber: Regulates suction

Types of Suction

• Wet Suction:
  • Regulated by water height in suction control chamber
  • Requires filling with water as ordered (usually -20 cm)
  • Continuous bubbling normal
• Dry Suction:
  • No water column, uses suction monitor bellow
  • Adjustable via rotary suction dial
  • No bubbling or evaporation issues

Nursing Interventions

• Monitor:
  • Respiratory status
  • Drainage system
• Actions:
  • Ensure system below chest level
  • Secure tubing connections
  • Record drainage: <100cc/hr typical
• Chamber Monitoring:
  • Water Seal Chamber: Fluctuates with breathing
  • Air Leak Monitor: Check for excessive bubbling
  • Suction Control: Check gentle bubbling (wet), monitor bellow (dry)
• Additional Checks:
  • Lung sounds, breath rate, dyspnea
  • Insertion site for infection
  • Subcutaneous crepitus
  • Patient cough and deep breath

Troubleshooting

• Dislodged Tube: Cover site with sterile dressing taped on three sides, notify physician
• System Breaks: Insert tubing into sterile water, replace system
• Avoid:
  • Milking/Stripping tubing
  • Clamping without order

Chest Tube Removal

• Procedure:
  • Prepare supplies: gloves, dressing, mask, suture kit
  • Teach Valsalva maneuver to prevent air entering pleura space
  • Premedicate for pain if ordered
  • Monitor post-removal: respiratory status, lung sounds
  • Follow up with chest x-ray

Conclusion

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