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Potential Complications and Interventions for Chest Tube Malfunction or Removal

- The potential complications and interventions for chest tube malfunction or removal are: Open in browser

Complication

Description

Intervention

Infection

A bacterial invasion of the pleural space or wound site that causes fever, chills, increased white blood cell count, purulent drainage, redness, swelling, or pain.

Administer antibiotics as ordered. Monitor vital signs and wound site. Change dressing using sterile technique. Obtain cultures as ordered.

Bleeding

A hemorrhage from the chest tube insertion site or from the lung or pleural vessels that causes increased drainage (>100 mL/hour), bright red drainage, hypotension, tachycardia, pallor, or decreased hemoglobin.

Apply pressure dressing to the wound site. Monitor vital signs and drainage. Notify the physician. Administer fluids and blood products as ordered. Prepare for surgery if needed.

Air leak

A leakage of air from the chest tube system that causes continuous bubbling in the water-seal chamber or a loss of tidaling.

Locate the source of air leak by clamping the tubing at different segments (starting from the chest) until bubbling stops. If leak is in the tubing or drainage system, replace or repair it. If leak is in the chest tube or wound site, notify the physician. Apply occlusive dressing to seal wound site.

Tension pneumothorax

A life-threatening condition where air accumulates in the pleural space and causes increased intrathoracic pressure that compresses the lung and shifts the mediastinum to the opposite side. It causes severe dyspnea, hypoxia, hypotension, tachycardia, tracheal deviation, jugular venous distension, absent breath sounds on affected side.

Release any clamps on the tubing. Assess for kinks or obstructions in the tubing. Notify the physician immediately. Prepare for needle decompression or chest tube insertion on affected side. Administer oxygen as ordered. Monitor vital signs and oxygen saturation.

Subcutaneous emphysema

A condition where air escapes into the subcutaneous tissue around the chest tube insertion site or wound site. It causes crepitus (crackling sensation) on palpation.

Notify the physician. Monitor respiratory status and oxygen saturation. Administer oxygen as ordered. Elevate head of bed to facilitate breathing.

Re-expansion pulmonary edema

A rare but serious complication where fluid accumulates in the lung tissue after rapid re-expansion of a collapsed lung. It causes dyspnea, hypoxia, coughing up pink frothy sputum, crackles on auscultation.

Notify the physician immediately. Administer oxygen as ordered. Monitor vital signs and oxygen saturation. Administer diuretics as ordered. Prepare for intubation or mechanical ventilation if needed.

- The procedure for chest tube removal involves:

  • Obtaining a physician’s order and informed consent from the patient
  • Administering analgesia or sedation as ordered
  • Preparing sterile supplies such as dressing, suture removal kit, petroleum gauze
  • Positioning the patient in semi-Fowler’s position with affected arm raised above head
  • Instructing the patient to perform Valsalva maneuver (exhale forcefully with mouth closed) or hold breath at end expiration
  • Cutting sutures and removing chest tube quickly with one motion
  • Applying occlusive dressing with petroleum gauze over wound site
  • Instructing patient to resume normal breathing
  • Obtaining a

- Obtaining a chest x-ray to confirm chest tube removal and absence of pneumothorax

  • Monitoring and assessing the patient’s respiratory status, vital signs, pain level, wound site, and dressing for any signs of complications such as infection, bleeding, air leak, or pneumothorax
  • Educating the patient and family about the wound care, activity restrictions, signs and symptoms to report, and follow-up care

 

Questions on Potential Complications and Interventions for Chest Tube Malfunction or Removal

Correct Answer is C

Explanation

Overproduction of glucagon by the pancreas is not the primary cause of elevated blood sugar levels and excessive thirst. Glucagon, a hormone produced by the pancreas, raises blood sugar levels when necessary, but it is not the main culprit in diabetes.

Correct Answer is ["B","D"]

Explanation

Lean protein is a good choice for individuals with diabetes as it can help stabilize blood sugar levels and promote satiety without contributing to significant fluctuations in glucose.

Correct Answer is B

Explanation

Using adhesive tape to treat blisters or sores on the feet is not advised. Any wounds or foot issues should be assessed and treated by a healthcare professional to prevent infection and promote proper healing.

Correct Answer is A

Explanation

"My heart has been racing throughout the day”. is also not indicative of hypoglycemia. Rapid heart rate (tachycardia) can have multiple underlying causes, and it is not a primary symptom of low blood sugar.

Correct Answer is B

Explanation

Checking the client's oxygen saturation is not directly related to insulin administration for diabetes. It may be relevant in certain medical conditions or emergencies, but it is not a priority action before giving insulin.

Correct Answer is D

Explanation

While an intravenous infusion pump can be used for insulin administration in some situations, it is not the best choice for rapidly correcting hyperglycemia. Intravenous bolus injection provides a more immediate and precise response. Infusion pumps are more commonly used for continuous insulin infusions, such as in critical care settings.

Correct Answer is E

Explanation

Monitoring blood glucose levels more frequently is essential for clients with diabetes experiencing hypoglycemic episodes. By regularly checking blood glucose levels, the client and healthcare team can identify trends and adjust insulin or medication dosages appropriately, helping to prevent future hypoglycemic episodes.

Correct Answer is D

Explanation

Instructing the patient to take deep breaths during the insertion is not appropriate because chest tube insertion is a sterile procedure, and patients are usually not conscious during the process. The insertion site is anesthetized, and deep breaths could compromise sterile technique and increase the risk of infection.

Keeping the tubing free of kinks, loops, or dependent areas is correct. Any kinks, loops, or dependent areas can obstruct the flow of fluids and air within the chest tube system, impairing its functionality.

Notifying the physician immediately about the air leak is the appropriate nursing action. Continuous bubbling in the water-seal chamber suggests an air leak, which could compromise the effectiveness of the chest tube and require immediate medical attention.

Instructing the client to take slow, deep breaths to prevent further complications is incorrect. The client's condition requires urgent medical intervention, and slow, deep breaths would not address the acute issue of increased intrathoracic pressure and compromised lung function.

The nurse should inform the patient that the drainage color may change from serosanguineous (pale, pink, or slightly bloody) to bright red during the recovery process. Initially, the drainage may be bloody, but as healing progresses, it should become clearer. However, if the drainage suddenly become

Monitoring vital signs and oxygen saturation is essential but does not address the infection directly. Vital sign monitoring is ongoing, while obtaining cultures is a specific intervention targeted at the suspected infection.

Infection does not explain the sudden decrease in drainage and pink frothy sputum. Although obtaining cultures from the chest tube site is important to assess for infection, it is not the most appropriate intervention at this moment. The priority is to address the potential tension pneumothorax.

<p>Applying an occlusive dressing with petroleum gauze over the wound site after removal is not the standard practice. Rationale: After chest tube removal, the wound site is typically left open to allow for the drainage of any residual air or fluid. Applying an occlusive dressing can trap air or flu
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