Page 90 - Critical Care Nursing Demystified

Chapter 2 CARE OF THE PATIENT WITH CRITICAL RESPIRATORY NEEDS 75

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1. Observe for a health care provider’s order and signed consent form.
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3. Teach what will happen during the procedure.
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4. Obtain supplies, which generally include chest tube insertion tray, site analgesic,
chest tubes, NSS (Normal Saline Solution) (if not using a prefilled system), petro-
leum-impregnated gauze, chest tube clamps, and chest tube catheters.
5. Perform baseline vital signs and SaO ; auscultate lung fields.
2
6. Monitor the sterile field and support the patient.
7. Set up the chest tube according to manufacturer’s guidelines; this may include
pouring NSS into the water seal to the “fill level” and suction control chamber
to the amount of suction ordered.
8. Attach the suction control port to long tubing to wall suction. Turn the wall Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
suction up until the suction control chamber gently bubbles.
9. Prepare the long patient tubing to attach to the chest tube catheter once the
physician has the tube in place. Tape according to hospital policy.
10. Assist the physician in placing a sterile dressing over the insertion site once the
tube is in place.
11. Make sure a chest x-ray is completed after the chest tube is in place.
12. Monitor the site for bleeding and crepitus after the procedure and perform
vital signs as per institutional protocol.
13. Ongoing care of chest tubes includes
a. Monitoring the insertion site for bleeding, crepitus, and infection at the begin-
ning of the shift and prn.
b. Observing the amount, clotting, and color of exudate in the tubing and
drainage unit.
c. Keeping the tubes unkinked and below the level of the patient.
d. Observing the water seal chamber for fluctuation and degree of air leak if a
pneumothorax is present.