Chest Tubes: Documentation and Special Considerations (Nursing)

by Samantha Rhea, MSN, RN

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    00:04 Okay, guys, I know that was a lot of steps.

    00:06 But really important to document as you know, we've set up our system, we've monitored our patient, now we get to document.

    00:14 So many times when you're documenting chest tubes, much of your facility is going to have a light tronic medical record, for example.

    00:22 And typically, there's a flow sheet that you can choose the chest tube, and there's lots of components in there that are already preset for you.

    00:29 But a few key things to make sure that you document, these 6 specifically.

    00:35 You want to make sure you document the chest drainage system, the catheter securement.

    00:40 And don't forget about that really important air leak, is there one in there or not? We want to make sure we document the site appearance, what kind of dressing and also don't forget to document the characteristics of the drainage.

    00:54 Now these 6 important points should always be included in your documentation.

    00:59 Now, you may see an electronic medical record like this and the flow sheet we just discussed.

    01:05 Typically, there's an expansion arrow where you can drop down and look at your choices.

    01:10 Now take your time as a new nurse documenting this, get familiar with these topics and make sure you look through and document thoroughly.

    01:18 Okay, guys, I know that was a lot about chest tube care, but it's a really important topic.

    01:24 And before you go today, I want to talk about 6 crucial points to take away in regards to taking care of a chest tube client.

    01:33 So one potential complication is infection.

    01:37 Think about that anytime you have a foreign object inserted into a patient's body cavity, infection is a huge risk.

    01:44 So monitor for the signs and symptoms of that.

    01:48 And especially if it's a new chest tube, there can be a lot of pain associated.

    01:52 So please assess your client regularly.

    01:56 Now next, there can be air leak at the insertion site.

    01:59 Now one key point to think about, make sure you trace those lines.

    02:03 Always trace the lines in the tubing and look for any disconnection in the tubes itself.

    02:08 Also a good thing to remember, check the dressing site, sometimes that dressing maybe peels up so we want to check that as well.

    02:16 Now when we're talking about air leaks, don't forget about that air leak monitor.

    02:21 That's a really helpful point for us.

    02:23 Now, anytime you're talking about air leaks, keep a petroleum gauze or whatever the agency preferences in regards to air leak coverage close by your patient's bedside.

    02:34 Okay, so we're almost there.

    02:36 I want to talk about these last half of these complications with you.

    02:40 One thing that can also happen is a tubing disconnection.

    02:44 So one remedy for that, if that comes up, also have sterile water at the bedside.

    02:50 So if a tubing gets disconnected, you can take the tubing and plunge it into the sterile bottle itself.

    02:58 Now let's pause a moment on this really important potential complication.

    03:03 Okay guys, are you listening? Okay, accidental dislodgement.

    03:07 Now what I'm talking about that is not the tubing.

    03:11 I'm talking about the chest tube coming out of the patient's body cavity.

    03:16 So you can imagine if I have a tube, and it comes out of the patient's body cavity.

    03:22 Now that's there for the lung, the lung can really deflate like a balloon.

    03:26 Can you imagine how you would be able to breathe like that? That is a medical emergency.

    03:32 So if a patient has an accidental dislodgement, make sure you always keep a vaseline gauze and occlusive dressing with you.

    03:40 Here's a story for you.

    03:42 I've had a nurse tell me she was on the elevator with a patient and the chest tube came out of the patient's body cavity.

    03:49 So that just tells you always have a gauze and an occlusive dressing specifically a vaseline gauze next to you and every time you're with a patient with a chest tube.

    04:00 Now if this gets this large, obviously you've got to call the doctor immediately.

    04:06 Now lastly, before you leave, another thing that can occur is chest tube occlusion.

    04:11 So first things first, remember about that tubing, check if there's any kinks.

    04:16 Also, if you remember from earlier, make sure that system is below the level of the patient's chest.

    04:22 And if we can't remedy that, again, call your doctor.

    04:25 Thanks for listening.

    About the Lecture

    The lecture Chest Tubes: Documentation and Special Considerations (Nursing) by Samantha Rhea, MSN, RN is from the course Chest Management Tube Care (Nursing).

    Included Quiz Questions

    1. “I only need to document on my client if there is an air leak.”
    2. “I need to remove my client’s dressing at the chest tube insertion site several times a day so that I can document its appearance.”
    3. “I need to include in my documentation that the chest tube is securely connected to the drainage system.”
    4. “I need to describe the characteristics of the chest tube drainage.”
    1. “I need to monitor the client’s chest tube insertion site for signs of infection.”
    2. “I need to keep a container of sterile water at the client’s bedside in case the tubing gets disconnected.”
    3. “An air leak is only detectable by looking for bubbles in the air leak monitor.”
    4. “If the chest tube gets dislodged from the client, I need to quickly reinsert it before calling the doctor.”

    Author of lecture Chest Tubes: Documentation and Special Considerations (Nursing)

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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