Chapter 10: Tubes and Devices
10.6 Chest Tube Drainage Systems
Critical Thinking Exercises: Questions, Answers, and Sources / References
- What should you do if your patient’s chest tube becomes disconnected from the chest tube drainage system?
Answer:
A chest tube drainage system disconnecting from the chest tube inside the patient is an emergency. Momentarily but immediately clamp the tube and place the end of chest tube in sterile water or NS. The two ends will need to be swabbed with alcohol and reconnected.
2. When a patient has a chest tube, what emergency supplies must be at the patient’s bedside at all times?
Have an emergency “accidental chest tube removal kit” at the bedside which includes: clamp, petroleum impregnated dressing, two sterile 4 × 4’s; container of sterile normal saline or sterile water, occlusion dressing, alcohol swabs.
Source:
Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2017). Clinical nursing skills and techniques (9th ed.). St. Louis, MO: Elsevier-Mosby.
Teleflex Medical Incorporated. (2009). Chest drainage systems. http://www.teleflex.com/en/usa/ucd/chest_drainage_systems.php.
- A patient has a chest tube attached to a water seal dry suction chest drainage unit for history of a pneumothorax. Bubbling is noted in the air leak meter. What might this signify? (select all that apply)
| Distractor | Answer | More information |
| An air leak | Correct | In a water seal wet suction chest drainage unit, bubbling is normal. In a dry suction chest drainage unit, bubbling suggests a leak somewhere. |
| The patient’s lung has re-expanded | Incorrect | Bubbling in a water seal dry suction unit suggests air leak. |
| The chest drainage unit is full | Incorrect | A chest drainage unit that is full will have all of the collection chambers filled with liquid but should have air bubbling for that reason. |
| Normal changing pressure in the pleural space as the patient breathes | Incorrect | Bubbling in a water seal dry suction chest drainage do not bubble. The nurse might see tidalling or movement of any liquid drainage in the drainage tubing to suggest changing pressure in the pleural space |
Source: Teleflex Medical Incorporated. (2009). Chest drainage systems. Retrieved from http://www.teleflex.com/en/usa/ucd/chest_drainage_systems.php.
2. When assessing a client with a chest tube, the nurse notes crepitus under the skin surrounding the chest tube. The nurse’s response should be:
| Distractor | Answer | More information |
| One of great concern | Incorrect | The crepitus represents subcutaneous emphysema which is air under the skin and is not harmful. Presence of subcutaneous emphysema however requires assessment for possible cause and to determine it doesn’t worsen |
| Call the prescriber immediately | Incorrect | The crepitus represents subcutaneous emphysema which is air under the skin and is generally not harmful. It can become harmful if it involves the neck and affects airway patency. Presence of subcutaneous emphysema however requires assessment for possible cause and to determine it doesn’t worsen and report to the prescriber. |
| Reassure the patient that this is normal | Correct | The crepitus represents subcutaneous emphysema which is air under the skin and is generally not harmful. It can become harmful if it involves the neck and affects airway patency. Presence of subcutaneous emphysema however requires assessment for possible cause and to determine it doesn’t worsen and report to the prescriber. |