The Chest Tube is a great device, but like all electronics, it sometimes has its issues. If your Chest Tube is not working, take a look at this troubleshooting guide.
We’ve collected answers to the most frequent reasons you’ll see Chest Tube not working and explained them in plain language for easy troubleshooting.
Quick Fix
To troubleshoot a chest tube, check for proper placement and secure connections, ensure the drainage system is below chest level, confirm the water seal chamber is bubbling appropriately, look for kinks or clots in the tubing, and assess the patient for signs of respiratory distress.
Respiratory Distress Cues and Interventions
As you monitor patients with chest tubes, you must be vigilant for respiratory distress cues, which can quickly escalate into life-threatening complications.
Look for oxygen saturation levels below 90%, decreased breath sounds, asymmetric chest movements, and other signs of distress. If you identify any of these cues, verify the chest drainage system is intact and provide oxygen as indicated.
Notify the provider promptly and be prepared to provide emergency assistance if needed. Undetected respiratory distress can lead to serious complications, including tension pneumothorax, making timely interventions vital.
Air Leak Detection and Management
You play a critical role in detecting air leaks, a common complication in patients with chest tubes.
Check the water seal chamber for continuous or intermittent bubbling, and listen for audible air leaking from the patient’s chest.
If you detect an air leak, clamp the chest tube momentarily to determine the source, reinforce the dressing, and notify the provider.
Air leaks can be normal initially, but persistent ones require further intervention.
Alert the provider to new or persistent air leaks, which can be managed by adjusting the suction level, repositioning the patient, or replacing the chest tube.
Dislodged Chest Tube Identification and Care
When managing chest tubes, it’s not uncommon to encounter air leaks, but another critical complication to be aware of is a dislodged chest tube.
You must identify it promptly, watching for cues like respiratory distress, sudden changes in vital signs, or visible tube dislodgement.
If you suspect a dislodged tube, cover the chest tube insertion site with a sterile occlusive dressing, call for assistance, and prepare for reinsertion of a new tube.
Help the patient cough and exhale to prevent air from re-entering the pleural space.
Notify the provider immediately to arrange for a chest x-ray and potential reinsertion of a new chest tube.
Accidental Disconnection Prevention and Response
Chest tube management demands diligence, and accidental disconnections can have devastating consequences.
You must take preventive measures to avoid this complication.
To prevent accidental disconnections, follow these steps:
- Secure the chest tube to the chest with tape or a securement device, ensuring a snug fit to prevent accidental pulling.
- Clamp the chest tube when not in use to prevent air from entering the pleural space.
- Regularly inspect the chest tube and its connections for signs of wear or damage, replacing them as needed.
If an accidental disconnection occurs, respond promptly by clamping the chest tube and evaluating the patient’s condition.
Bleeding at the Insertion Site Control
Bleeding at the insertion site is a common complication of chest tube placement, and it’s vital to take proactive measures to control it.
When you notice bleeding, apply gentle pressure to the site using a sterile gauze for 5-10 minutes to promote clotting. If bleeding persists, consider applying a topical hemostatic agent or suturing the site.
Monitor your patients’ chest closely for signs of bleeding, such as increased chest tube output or ecchymosis on the chest wall. Prompt recognition and control of bleeding can prevent further complications and improve patient outcomes.
Subcutaneous Emphysema Recognition and Management
Subcutaneous emphysema, a potentially serious complication of chest tube placement, can occur when air leaks into the subcutaneous tissue, causing noticeable swelling and palpable crepitus.
You must recognize and manage this complication promptly to prevent further complications.
To identify subcutaneous emphysema:
- Inspect the chest tube insertion site for swelling, redness, or palpable air bubbles.
- Check for bubbling in the water seal chamber during inspiration.
- Assess the patient for signs of respiratory distress, such as tachypnea or tachycardia.
Immediate action is necessary to prevent respiratory compromise.
Sudden Increase in Bright Red Drainage Response
When you encounter a sudden increase in bright red drainage from the chest tube, you must quickly assess the patient’s essential signs to identify any signs of instability.
This critical finding warrants immediate notification of the provider, as it may indicate a life-threatening complication, such as bleeding or hemothorax.
Your prompt response is pivotal in preventing further deterioration and ensuring timely intervention.
Vital Sign Assessment
Your patient’s key signs can alert you to a sudden increase in bright red drainage, prompting a swift response.
Check essential signs immediately, focusing on respiratory rate, oxygen saturation, and heart rate.
- Assess breath sounds to identify any changes, such as decreased or absent breath sounds on the affected side.
- Monitor for signs of tension pneumothorax, including tracheal deviation, jugular venous distension, and decreased breath sounds.
- Evaluate the patient’s overall clinical status, including level of consciousness and skin color, to determine if they’re experiencing respiratory distress.
Notify Provider Immediately
A sudden increase in bright red drainage from the chest tube demands immediate attention and prompts you to notify the provider without delay.
This could indicate a significant bleeding event, which requires prompt intervention. When notifying the provider, be prepared to report the amount and characteristics of the drainage, as well as any changes in the patient’s crucial signs.
The provider may order an urgent chest X-ray to assess lung expansion and rule out complications. Meanwhile, guarantee the suction control is set correctly to prevent further bleeding.
Notify the provider immediately to initiate timely interventions and prevent adverse outcomes.
Drainage System Maintenance and Troubleshooting
You play a critical role in maintaining the drainage system to guarantee effective chest tube function.
To prevent complications, you must monitor the system regularly, checking for air leaks, proper fluid levels, and correct suction settings.
Drainage Unit Issues
Proper positioning of the drainage unit is crucial to facilitate efficient drainage and prevent backflow.
Certify the unit is positioned below the level of the insertion site and below the patient.
Check the unit for the following:
- Tidaling: Certify the water level oscillates with breathing.
- Suction: Verify suction is set to the ordered level and wall suction is sufficient (at least -80 cmH2O).
- Water seal: Disconnect tubing to allow free flow of air and check for orange bellows expansion on the Atrutto unit.
Remember to vent an overfilled water seal or suction control chamber to prevent system malfunction.
Air Leak Detection
The prompt detection of air leaks in the drainage system is critical, as it can prevent respiratory distress, pneumothorax, and even life-threatening tension pneumothorax.
You’ll know you have an air leak if you notice continuous or intermittent bubbling in the water seal chamber or hear audible air leaking from the patient’s chest.
To troubleshoot, clamp the chest tube momentarily to determine the source of the leak, then reinforce the dressing and notify the provider.
You can quantify the air leak by marking the level of bubbling in the water-sealed chamber to monitor changes over time.
System Monitoring Tips
Effective system monitoring is crucial to guarantee the proper functioning of the drainage system, and it starts with proper positioning of the drainage unit.
Certify it’s below the level of the insertion site and patient to facilitate drainage. Check for tidaling, the oscillation of the water level due to changing intrapleural pressures during breathing.
- Verify suction is set to the ordered level by the provider, and check wall suction is sufficient, with at least -80 cmH2O.
- Disconnect tubing from the unit to allow free flow of air when on water seal.
- Check for orange bellows expansion on the Atrium unit, guaranteeing suction isn’t too high, which can cause problems for the patient.
Preventing Complications in Chest Tube Management
You should take a proactive approach to preventing complications in chest tube management, as even minor issues can lead to serious consequences, including extended hospital stays, increased healthcare costs, and decreased patient outcomes.
Guarantee the chest tube is properly secured and positioned to prevent kinking or obstruction, which can impair drainage and suction.
Regularly inspect the tube and drainage system for signs of malfunction or blockage.
Implement a routine of daily chest tube checks to identify potential issues before they escalate into major complications.
Chest Tube Removal and Post-Removal Care
When preparing for chest tube removal, you must verify that written documentation for drain removal is complete and accurate in the patient’s EMR, specifying which drain/s are to be removed.
You’re also responsible for reviewing the patient’s post-operative x-ray prior to removal to confirm the tube’s position and potential complications.
Proper removal technique, including clamping and cleaning the drain, is vital to preventing post-removal complications, which you must be prepared to address.
Removal Preparation
To guarantee a smooth and safe chest tube removal process, thorough preparation is crucial to certify.
You should verify written documentation is in place, specifying which drain/s are to be removed, and the proceduralist removing drains checks the patient’s post-operative x-ray prior to drain removal.
Before removal, remember to:
- Clamp the drain tubing at the patient end and clean the ends of the drain.
- Physically check drain labelling to verify removal of the correct drain/s.
- Assess the patient’s skin at the insertion site for pressure injuries.
Post-Removal Complications
During chest tube removal, complications can arise, and being prepared for these potential issues is vital to guarantee superior patient care.
After removal, you must monitor the patient for signs of pneumothorax, such as increased suction or water-sealed drainage. Guarantee the pleural space isn’t exposed to air by maintaining a water-seled system.
If accidental removal occurs, apply pressure to the exit site and seal with steristrips. Notify the responsible medical team to review the patient and consider the need for a suture.
Be prepared to address any post-removal complications promptly to guarantee prime patient outcomes.
Frequently Asked Questions
How Do You Troubleshoot a Chest Tube?
You troubleshoot a chest tube by first verifying tube placement using X-rays, ensuring tube security by checking for air leaks, and inspecting for tube stripping, which can compromise drainage and lead to complications.
What Does Bubbling and Swinging Mean in a Chest Drain?
Like a stormy sea, your chest drain’s bubbling and swinging can be turbulent. Bubbling in the water-sealed chamber indicates an air leak, while swinging, or tidaling, reflects drainage dynamics and tube placement, revealing fluid accumulation and changes in intrapleural pressure.
How to Know if a Chest Tube Has an Air Leak?
You identify an air leak in a chest tube by inspecting the tube for signs of leakage, listening for audible sounds, and monitoring for continuous or intermittent bubbling in the water seal chamber during sound monitoring.
How Do You Know if Your Chest Tube Is Clogged?
You’re likely familiar with the fact that 1 in 5 chest tubes becomes occluded; now, to identify a clogged tube, look for signs of tube obstruction, such as fluid buildup, suction failure, or inconsistent drainage, which can compromise patient outcomes.
Conclusion
You’ve mastered the art of chest tube troubleshooting! With these expert strategies, you’ll detect respiratory distress and air leaks in a flash, respond to dislodged tubes and accidental disconnections with lightning speed, and prevent complications like a pro. Your patients will breathe easier, and your confidence will soar! Remember, vigilant monitoring and swift intervention are key to avoiding catastrophes and ensuring seamless chest tube management.
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