A patient is one day post-thoracotomy with a chest tube connected to a closed-chest drainage system to wall suction. Which assessments and interventions should the nurse include in routine shift care? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Chest tube nursing care: (1) inspect drainage each shift for character and amount, mark the chamber with date/time and shift level — sudden increase >100 mL/hr or bright red drainage warrants immediate notification; (2) keep system below the chest, check tubing free of kinks, dependent loops, and clots — these all impede drainage and can produce a tension pneumothorax; (3) assess tidaling — fluctuation of water in the water-seal chamber with respiration confirms patency; cessation can mean lung re-expansion (good) or obstruction (bad), distinguished by clinical assessment; (5) keep clamp, sterile occlusive dressing, and bottle of sterile water at bedside — clamp is for chamber change only, occlusive dressing for tube dislodgement at chest wall, sterile water for system disconnection (immerse end of tubing in water to maintain water seal). Choice 1 is incorrect — routine stripping or milking is no longer recommended; it generates dangerously high negative pressure that can damage lung tissue and is reserved for documented obstruction by clot per institutional policy.
A closed-chest drainage system has three chambers — collection (drainage from the patient), water seal (a one-way valve that prevents air re-entry and shows tidaling and air leak), and suction control (regulating negative pressure via a water column or dial) — and must always sit below the patient's chest. Routine clamping is forbidden because it risks tension pneumothorax; only brief clamping is allowed for system change or per provider order. Tidaling describes water in the water-seal chamber rising with inspiration (negative intrathoracic pressure) and falling with expiration in a spontaneously breathing patient (reversed with positive-pressure ventilation); continuous bubbling in the water seal indicates an air leak (check connections, then patient), and cessation of tidaling means lung re-expansion (no longer needed) or obstruction (still needed, problem). Emergency bedside supplies include a padded clamp (for system change only, never routine), a sterile occlusive dressing (for tube dislodgement at the chest wall, taped on three sides as a tension-pneumothorax precaution), and sterile water (for accidental system disconnection — immerse the patient end of the tubing in the water to maintain the water seal until the system is replaced).
A patient is 1 day post-thoracotomy with a chest tube connected to a closed-chest drainage system to wall suction. The nurse plans routine shift care.
Closed-Chest Drainage System Compartments — Three chambers: collection (drainage from patient), water seal (one-way valve, prevents air re-entry, shows tidaling and air leak), suction control (regulates negative pressure via water column or dial). Always below the chest. Never clamp routinely (risk of tension pneumothorax) — only briefly for system change or per provider order.
Tidaling and Air Leak — Tidaling: water in the water-seal chamber rises with inspiration (negative intrathoracic pressure) and falls with expiration in a spontaneously breathing patient (reverse with positive-pressure ventilation). Continuous bubbling in the water seal indicates an air leak — check connections, then patient. Cessation of tidaling: lung re-expansion (no longer needed) or obstruction (still needed, problem).
Emergency Bedside Supplies — Padded clamp (for system change only — never routine), sterile occlusive dressing (for tube dislodgement at the chest wall, taped on three sides for tension pneumothorax precaution), sterile water (for accidental system disconnection — immerse the patient end of the tubing in the water to maintain water seal until system is replaced).