00:04
Let's take a look at the skill
"Chest tube monitoring and care".
00:08
So this is going to happen routinely
and maybe at medical surgical unit
or an intensive care unit.
00:15
So before we get started,
don't forget your hand hygiene
and provide privacy
for your patient.
00:20
Now we want to make sure we explain the
procedure to our patient and put on gloves.
00:26
Now, this is a great
time to complete
a respiratory and pain
assessment from our patient.
00:30
Now, if you remember, they just had a
chest tube inserted by the physician,
this can be really painful.
00:36
So while the patient has a chest tube,
make sure you assess your patient.
00:41
Now we also want to check the vital
signs as another part of the assessment
and look for any
indications of distress.
00:49
With the collection system,
we want to note the character,
the consistency and the amount of
drainage in the collection chamber.
00:57
Now this really needs to
be done at regular intervals.
01:00
Now one way we can do this
is mark the drainage level
with a marker on the
actual system itself
by noting the date and the
time on the collection chamber.
01:11
So if you ever go into a unit
and take a look at a chest tube
that may be the patient's
had for a few days,
you'll see lots of notes, lots of
marks, dates and initials on there.
01:21
Don't forget to check for fluctuations
in the air leak monitor with each breath.
01:25
And don't forget the air leak
monitors are really important piece
on chest tube
monitoring and care.
01:31
If there's any air leak,
this is where we're going to see it.
01:34
So look for bubbling here.
01:36
Now if the chest tube drainage
system is placed the suction,
ensure that suction is present.
01:42
And we're going to know this
by the suction control chamber.
01:46
Now if you remember on
a wet suction system,
it's controlled by
the level of the water
and we should see a little
bit of bubbling here.
01:54
Now where do we not want
bubbling, the air leak monitor.
01:57
Suction control chamber, that's where
we're going to want to see bubbling.
02:02
Now we want to ensure the
integrity of the drainage tubing,
we want to check this for any
kinks, any weird loops,
we want to make sure
that stays nice open
and so drainage and
suction can be facilitated.
02:15
Now we talked a lot about
monitoring the actual system itself.
02:19
Don't forget about your patient and
especially where the chest tubes inserted.
02:23
Don't forget to palpate the
chest tube dressing for crepitus.
02:27
Okay, what is crepitus?
So just think about
crepitus, rice krispies
that doesn't even sound
like it's related, right.
02:35
But all this means that there's going
to be an air leak underneath the skin.
02:39
So if you palpate that
chest tube dressing,
you may feel kind of like
a rice crispy feeling
that's not a good sign,
we need to call the doctor.
02:47
What this means is there's an
air leak underneath the skin.
02:51
So when we palpate
around that dressing,
we're going to palpate
around the dressing itself,
that side of the chest tube and
even all the way up to the neck.
02:59
So there can be air leaks here
and we want to assess for that.
03:03
Now if able, change the chest
tube dressing if it's soiled
or if it's ordered by
the healthcare provider.
03:09
We just talked about
what suction monitoring,
now let's take a
look at the dry.
03:13
Now just as we did before,
we're going to note the character,
consistency and the amount of
drainage in the collection chamber.
03:20
This really needs to be done each
shift and at regular intervals.
03:24
Now we can mark that
drainage level with a marker
by noting the date and the time
on the collection chamber itself.
03:32
Now if you remember that air
leaks a really important place
to look at air leak monitor.
03:38
And just like the wet,
the dry has one too.
03:41
So just as a refresher,
if you see bubbling from right to left
in the air leak monitor,
we need to call our physician.
03:48
And one more thing,
what about the severity
of the air leak?
Well, we can check this in
this monitor from the numbers
and how much bubbling and
how far left it reaches.
03:58
So 1 is low,
all the way up to 5 is high.
04:02
So if you can imagine the higher
the number, the worse the air leak,
so keep an eye on this.
04:09
Now with dry suction,
this is where it differs.
04:12
Now this one has the specific
controlled setting for us
like the -10, -20 for example.
04:18
It also has this bellow.
04:20
So at this image here,
this shows you the bellow
which is associated
with dry suction.
04:25
Now we want to make sure
suction is working properly.
04:29
And how we do this is
by checking that bellow.
04:32
We want that at the level at the
indicator or even a little past
so just make sure you check this
when dry suctioning is occurring.
04:40
We also want to check the
integrity of the drainage too.
04:43
Make sure it's free of kinks.
04:46
And don't forget to look at
the chest tube dressing itself.
04:50
We talked a lot about the system
but always go back to your patient.
04:54
So palpate around that
chest tube dressing.
04:57
Now if there's a problem,
sometimes you may palpate
or feel some like rice crispy
feeling underneath the skin,
that's an issue because air
has leaked underneath the skin.
05:07
Now that feeling can go
from the chest tube dressing
all the way up to the
lateral side of the patient,
all the way even
up to their neck.
05:15
So make sure you're assessing
your patient thoroughly.
05:17
Now if able, change the chest
tube dressing if it's soiled
or ordered by the
health care provider.
05:23
Now after the system
has been set up,
let's take a look at a few
considerations that are really important.
05:29
For example, place that drainage system
below the level of the patient's chest.
05:34
I know we've mentioned this earlier,
but I can't emphasize this enough.
05:38
Also for convenience,
you can hang the system at the bedside
with the hooks that
come with the system.
05:45
Now sometimes we may have to
put that system on the floor
and there's foot
stands for that.
05:51
Also, don't forget to always check that
tubing and make sure it's free of kinks.
05:56
Now we can remove our gloves,
perform our hand hygiene
and make sure we
document that procedure.