chest drainage

Question 1

What conditions are chest drainage systems used to treat?

Answer 1

Spontaneous pneumothorax, traumatic pneumothorax, hemothorax

Question 2

What is the overall purpose of a chest drainage system?

Answer 2

Re-expand the lung and remove excess air, fluid, or blood

Question 3

Why do chest tubes help prevent cardiopulmonary complications?

Answer 3

Re-expansion of the lung restores ventilation and prevents hemodynamic compromise

Question 4

What factors influence which drainage system is used?

Answer 4

Provider preference, hospital system, and cost

Question 5

List the main types of chest drainage systems.

Answer 5

Traditional water seal; Dry suction water seal; Dry suction

Question 6

Is PleurX covered for testing in your notes?

Answer 6

No (NOT TESTED); like a JP drain for pleural effusion, chylothorax, or small hemo/pneumo

Question 7

What color is the water in the water-seal chamber and why?

Answer 7

Blue—so bubbling is easier to visualize

Question 8

What bubbling pattern is expected in the water-seal chamber?

Answer 8

Gentle, intermittent bubbling is okay

Question 9

What does continuous bubbling in the water-seal chamber suggest?

Answer 9

An air leak (abnormal)

Question 10

What is “tidaling” in the water-seal chamber?

Answer 10

Water level moves with respirations—this is normal

Question 11

What should you expect in the collection chamber for a pneumothorax?

Answer 11

Mostly air (little to no fluid)

Question 12

What should you expect in the collection chamber for a hemothorax?

Answer 12

Blood

Question 13

What do you do when the collection box is full?

Answer 13

Replace with a new unit (it comes as one piece)

Question 14

How often do you mark output on the collection chamber?

Answer 14

Once per shift; mark at eye level with date, time, and initials

Question 15

Where are chest tubes usually placed?

Answer 15

Mid- to anterior axillary line, 4th–5th intercostal space, tracking above the rib

Question 16

Why are chest tubes inserted above the rib?

Answer 16

To avoid the neurovascular bundle that runs along the inferior rib margin

Question 17

How should the tubing be laid out from bed to collection system?

Answer 17

In a straight line, dependent, with no kinks

Question 18

What should you avoid using on chest tube tubing?

Answer 18

Pins or restraints on the tubing

Question 19

How should connectors be secured?

Answer 19

Tape connectors to the body so the tube isn’t accidentally pulled out

Question 20

What checks are needed when the patient returns from a test?

Answer 20

Inspect entire setup: no kinks, suction functioning, connections taped securely

Question 21

What suction setting is used for chest tubes per your notes?

Answer 21

Continuous and standardized suction

Question 22

When must drainage be reported immediately?

Answer 22

If drainage exceeds 100 mL/hr

Question 23

How should drainage be documented?

Answer 23

Record amount and color in I/O and progress notes; mark chamber level each shift

Question 24

What does COCA stand for?

Answer 24

Color, Odor, Consistency, Amount

Question 25

What is meant by “maintain integrity of the drainage system”?

Answer 25

Keep a closed system: secure connections, no breaks, no kinks, water-seal intact

Question 26

When is “stripping” the tubing allowed?

Answer 26

Only with a provider order and if agency policy permits (most do not)

Question 27

Why is routine stripping avoided?

Answer 27

It can damage tubing and alter intrathoracic pressures

Question 28

If stripping is ordered, what is the method noted?

Answer 28

Pinch near the chest with one hand; lubricate thumb/forefinger to compress and slide toward the receptacle

Question 29

What emergency supplies should be kept at bedside?

Answer 29

Sterile water, rubber-tipped clamps, sterile dressings (dry gauze, petroleum gauze, tape)

Question 30

Why use petroleum gauze for the insertion site?

Answer 30

It’s occlusive and helps seal the site to prevent air entry

Question 31

If the system disconnects from the patient, what do you do immediately?

Answer 31

Wipe ends quickly with alcohol and reattach, or place the distal tube end in sterile water to re-establish the underwater seal

Question 32

If the chest tube is pulled out of the patient, what is the first action?

Answer 32

Apply an occlusive (petroleum) gauze dressing to the wound immediately (not a gloved hand)

Question 33

If the drainage system falls on the ground, what is the action?

Answer 33

Obtain a new system; meanwhile place the distal tube under sterile water to maintain the seal

Question 34

When may rubber-tipped clamps be used?

Answer 34

During planned removal or per provider order (not routine)

Question 35

Where should the drainage system be positioned relative to the patient?

Answer 35

Below the level of the bed to promote downward drainage

Question 36

When is clamping the tube appropriate?

Answer 36

Only if agency policy dictates or with specific order—otherwise risk of tension pneumothorax

Question 37

What patient assessments are ongoing with chest tubes?

Answer 37

VS, respiratory status, cardiovascular status—monitor regularly

Question 38

What aspects of chest tube function must be monitored?

Answer 38

Proper connections, no kinks, not clamped unintentionally, water-seal status

Question 39

What chamber findings require attention?

Answer 39

Continuous bubbling (air leak); absent tidaling may indicate obstruction or re-expansion

Question 40

What drainage threshold is concerning?

Answer 40

>100 mL/hr (report promptly)

Question 41

What local site issues must be monitored?

Answer 41

Dressing integrity, insertion site, signs of infection, subcutaneous emphysema

Question 42

What does subcutaneous emphysema indicate?

Answer 42

Air leak—air tracking into subcutaneous tissue

Question 43

Which dressing should NOT be used to occlude the site?

Answer 43

A gloved hand or plain dry gauze alone (non-occlusive)

Question 44

What’s the priority if a patient returns from radiology with new distress?

Answer 44

Reassess the entire chest tube system first (kinks, suction, connections, water-seal)