Hi, guys, welcome to the
topic of Chest Tubes.
So this is a really
overwhelming topic for some.
But if you'll hang with me, we're going to
talk about some really important concepts
to help you take care of
these type of clients.
So first of all,
why do we even need a chest tube?
Well, there's some
really important things.
So first of all,
it can remove air,
it can remove fluid and blood
from the space lining the lungs,
or the space between the
lung and the chest wall.
So how does this even happen?
Well, this can happen from
infection, lung disease,
cancer, or surgery,
and especially biopsies.
So another thing to
remember about a chest tube,
it can help create a negative pressure,
and it'll help the lung reinflate.
So how does this happen?
Well, if you think about if
someone gets trauma, for example,
like a motor vehicle accident,
or a penetrating chest wound like a
knife, or a gun shot,
while we're poking, basically like a hole
in a balloon, and that balloon can shrink,
that chest tubes really going
to be pivotal to help reinflate.
So one other important
note before we get too far
is that chest tube may or may
not be connected to suction.
So sometimes we need that
extra suction to remove fluid
and sometimes we can just
allow it to drain by gravity.
So just key note that
a healthcare provider
will order the amount
of suction as ordered.
So always notice,
if you are going to do suction,
there will be a specific
amount of suction that's order,
so make sure you check that.
So we just talked about some
really pivotal uses on chest tubes.
So now let's talk
Well, let's take a minute to look
at this image that we see here.
So you see in blue, this is the
patient's lungs that you're looking at.
Also, do you see that white cage look,
that is going to be your rib cage.
So when we talk about
before we move on,
I want you to note that word.
When we talk about intercostal, this
just means the spaces between two ribs.
So if you're looking
at this image,
and you see where that little
bitty tubes going through,
you see there's one rib,
a space and another rib,
the space in between those two ribs,
again, are your intercostal spaces.
And this is typically where
the chest tubes inserted.
So when we're talking about placing a
chest tube, and we need to remove air,
you're typically going
to see it up higher.
So think about air high to the sky and your
chest tubes higher, such a great cheat.
So you can see here with the
chest tube to remove air,
it's about the second intercostal
spaces where you're going to see that.
Now on the other side, on the other
tube, you see it's much lower.
So think about draining to
gravity or draining fluid.
Now this is much
lower on the rib cage.
And you're typically going to see this
about the fifth or sixth intercostal space.
So now let's look at the
drainage system itself.
This system alone
has come a long way.
So note that this is a
single self-contained unit.
Now you will see some
variations on this,
your physician may
have a preference.
Now your facility may
have a preference.
So just be familiar with the
one that your facility uses.
But we're going to walk you
through some commonalities
and some variations
on these systems.
So first, almost all systems are going
to have a suction control chamber.
This is important because it
regulates the amount of suction
and also helps
And systems are going to
have an air leak monitor.
This one's really important to
get to know and pay attention to
because if there's an
air leak in the system,
that can be a really bad complication
and a problem for your patient.
And don't forget the
Now this is where all the
drainage is going to accrue
and we need to
monitor this closely.
So let's take a moment to look
at some really common units
that you're going
to see on the floor.
You may see a wet suction
device or a dry suction device.
Again, it'll be surgeon
or facility preference.
So let's take a look
at some of the things
that are the same and
some that are different.
So if you see 1a here
on the wet suction side,
notice that there's a
level of water there.
That is how these sections control
through the wet suction device.
Now let's compare that to 1b.
So notice there's a really
nice pretty dial there for you.
It's got numbers such as
It makes it really easy to
figure out what suction method
or what pressure
that I needed that.
So that's the comparison
about the suction.
Now let's take a look at the
air leak monitor number 2.
Nice thing these things are the
You see that level of water.
Here is where we're going
to be able to determine
if there's an air
leak in our system.
If there's an air leak, this is a
problem and we need to call our doctor.
So again, air leak monitor
the same in each one.
Same thing with the
notice that there's little increments
is marked for levels on output for us,
which is really nice because
we can see how fast that
drainage is accumulating
in our collection chamber.
if you see on number 4 here,
both have a water sealed chamber and they
work as a one way valve on these systems.
Now one thing to know, do you see
on the dry suction side number 5,
you see that 5 marker and that little
orange bellow is what we like to call it.
This is really helpful because
this is a suction indicator,
and lets us know if the suction
is working properly or not.
Now we talked a lot about the
components of those chest tube.
Now let's look at some
troubleshooting tips for nurses.
Now specifically, let's talk about
air leaks and the correct suction.
Now, if you see this image
What is this called?
Do you remember?
This is the air leak monitor.
So as a nurse, if we're looking at
this, what should we do?
Is this good? Is this bad?
What do you think?
All right, so if you see continuous or
intermittent bubbling in this section,
this is something that we are
concerned, there may be an air leak,
hence the name air leak monitor.
Now clearly, there's going to be
severities of air leaks, right,
so we need to think about this.
So if you see bubbling,
that's moving from the right
closer to that one
number to the left,
that's going to be the indicator
for the severity of the air leak.
So there may be a situation where your
patients may be coughing, for example,
and maybe their air
leak is at maybe a 1-2,
that may not be an issue, but we need
to call the doctor and confirm this.
Now you can imagine if that bubbling
is going all the way to the left,
maybe at the 3, 4 or the 5,
that could indicate a severe air leak,
and we need to trace our
lines, contact our doctor.
Now let's look at the suction.
If you remember, this is a little
different depending on the system.
So let's look at the wet side.
So here we have a
wet suction unit.
So what's really important to
know if you remember what in water
that the suction is
controlled by water.
So it's really important to make
sure that the height of the water
is at the appropriate level.
And again, -20 is what you're
typically going to see for suction.
So I know we just talked about air
leaks, I don't want to freak you out.
But in the suction
you will see some
gentle bubbling in this.
This is how we know
the suction is working.
So don't let that alarm you.
So where should that air bubbling
be in the suction control chamber,
not the air leak monitor.
Now let's take a look
at the dry suction.
If you remember earlier,
this one's a lot different, right?
We've got this great dial
and it's got -20, -10, -30.
It's really easy to see that we're at
the appropriate suction level here.
But if you mere see that little
orange thing on the bottom,
that's what we call the bellow.
So the bellow should be
expanded past the indicator mark
so this is going to let us know that
the suction is working properly.
So don't get too hung up that that
bellow was right at that arrow.
It just should be expanded at or maybe
even a little pass that marker beyond.