Let's take a look at the skill "Chest tube monitoring and care".
So this is going to happen routinely and maybe at medical surgical unit
or an intensive care unit.
So before we get started, don't forget your hand hygiene
and provide privacy for your patient.
Now we want to make sure we explain the procedure to our patient and put on gloves.
Now, this is a great time to complete
a respiratory and pain assessment from our patient.
Now, if you remember, they just had a chest tube inserted by the physician,
this can be really painful.
So while the patient has a chest tube, make sure you assess your patient.
Now we also want to check the vital signs as another part of the assessment
and look for any indications of distress.
With the collection system, we want to note the character,
the consistency and the amount of drainage in the collection chamber.
Now this really needs to be done at regular intervals.
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.
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.
Don't forget to check for fluctuations in the air leak monitor with each breath.
And don't forget the air leak monitors are really important piece
on chest tube monitoring and care.
If there's any air leak, this is where we're going to see it.
So look for bubbling here.
Now if the chest tube drainage system is placed the suction,
ensure that suction is present.
And we're going to know this by the suction control chamber.
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.
Now where do we not want bubbling, the air leak monitor.
Suction control chamber, that's where we're going to want to see bubbling.
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.
Now we talked a lot about monitoring the actual system itself.
Don't forget about your patient and especially where the chest tubes inserted.
Don't forget to palpate the chest tube dressing for crepitus.
Okay, what is crepitus?
So just think about crepitus, rice krispies
that doesn't even sound like it's related, right.
But all this means that there's going to be an air leak underneath the skin.
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.
What this means is there's an air leak underneath the skin.
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.
So there can be air leaks here and we want to assess for that.
Now if able, change the chest tube dressing if it's soiled
or if it's ordered by the healthcare provider.
We just talked about what suction monitoring,
now let's take a look at the dry.
Now just as we did before, we're going to note the character,
consistency and the amount of drainage in the collection chamber.
This really needs to be done each shift and at regular intervals.
Now we can mark that drainage level with a marker
by noting the date and the time on the collection chamber itself.
Now if you remember that air leaks a really important place
to look at air leak monitor.
And just like the wet, the dry has one too.
So just as a refresher, if you see bubbling from right to left
in the air leak monitor, we need to call our physician.
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.
So 1 is low, all the way up to 5 is high.
So if you can imagine the higher the number, the worse the air leak,
so keep an eye on this.
Now with dry suction, this is where it differs.
Now this one has the specific controlled setting for us
like the -10, -20 for example.
It also has this bellow.
So at this image here, this shows you the bellow
which is associated with dry suction.
Now we want to make sure suction is working properly.
And how we do this is by checking that bellow.
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.
We also want to check the integrity of the drainage too.
Make sure it's free of kinks.
And don't forget to look at the chest tube dressing itself.
We talked a lot about the system but always go back to your patient.
So palpate around that chest tube dressing.
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.
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.
So make sure you're assessing your patient thoroughly.
Now if able, change the chest tube dressing if it's soiled
or ordered by the health care provider.
Now after the system has been set up,
let's take a look at a few considerations that are really important.
For example, place that drainage system below the level of the patient's chest.
I know we've mentioned this earlier, but I can't emphasize this enough.
Also for convenience, you can hang the system at the bedside
with the hooks that come with the system.
Now sometimes we may have to put that system on the floor
and there's foot stands for that.
Also, don't forget to always check that tubing and make sure it's free of kinks.
Now we can remove our gloves, perform our hand hygiene
and make sure we document that procedure.