CHEST TUBES
Harvey, G & McLean, H., (2019). Chapter 39, Cardiopulmonary functioning and oxygenation. In P. A.
Potter, A. G. Perry, P. A. Stockert, A. M. Hall, B. J. Astle, & W. Duggleby (Eds.), Canadian fundamentals
of nursing (6th Canadian ed.). Milton, Ontario, Canada: Elsevier Canada.
1. Why would a physician insert a chest tube?
To remove air and fluids from pleural place, prevent air or fluid from re-entering the pleural space, and reestablish normal pleural and intra pulmonic pressures.
2. Describe the pleural space of the chest cavity.
The pleural cavity is the potential space between the two pleurae (visceral and parietal) of the lungs. The
pleura is a serious membrane which folds back onto itself to form a two layered membrane structure. The
closely approved chest wall transmits pressures to the visceral pleura surface and hence to the lung.
3. Define pneumothorax and hemothorax.
Pneumothorax- a collection of air in the pleural space. The loss of negative intrapleural pressure causes
the lung to collapse.
Hemothorax- an accumulation of blood and fluid in the pleural cavity between the parietal and visceral
pleurae, usually because of trauma.
4. There are two types of drainage systems. One is a water seal drainage system has chambers
and a suction capability, the second has a mechanical one-way valve. Why is it important to
understand the concept of a sealed drainage system? Discuss from the occlusive dressing to
the drainage receptacle (Pleur Evac).
Water- seal chest drainage systems available in single, two, or three chamber systems.
Disposable, atrium, or pleural Evac chest drainage system- one-piece molded plastic units that provide
single or multiple chambers closed drainage system.
Disposable units can be a choice because they are cost effective and some facilitate autotransfusion,
used in open heart surgery.
Single chamber system- allows air from pneumothorax to bubble out of the water seal and escape
through air outlet, and it prevents air from re-entering.
Two or three chamber systems- drains through hemothorax and pneumothorax.
Nurses must maintain the water-seal system by placing the chest tube system upright. If it is tipped over,
the water seal becomes disrupted, and it creates a positive pressure which results in re-collapsing of the
lung.
5. What positions are appropriate for clients with chest tubes? Why?
The semi-fowlers position is appropriate for patients with pneumothorax because it permits optimal
drainage of fluid and air, as well as air usually rises to the highest point in the chest, which is typically
where the pneumothorax tube is located.
The high-fowlers position is ideal for patients with hemothorax because it permits optimal fluid drainage
as hemothorax tubes are placed on the mid axillary line, fifth or sixth intercostal space.
6. What position should the chest drainage system be in relation to the client? Why?
The drainage system should be upright and below the level of insertion. It should also be free of kinks or
dependent loops, or clotted drainage. All of these things are necessary for the tube to drain properly and
avoid infection and other complications.
7. Covered or shod hemostats (forceps that clamp) are kept at the top of the bed. Why is this an
important safety measure?
Shodded hemostats have a covering to prevent hemostat from penetrating the chest tube once changed.
The use of these shodded hemostats or clamps prevents air from re-entering the pleural space.
SUCTIONING AND TRACHEOSTOMY CARE
Harvey, G & McLean, H., (2019). Chapter 39, Cardiopulmonary functioning and oxygenation. In P. A.
Potter, A. G. Perry, P. A. Stockert, A. M. Hall, B. J. Astle, & W. Duggleby (Eds.), Canadian fundamentals
of nursing (6th Canadian ed.). Milton, Ontario, Canada: Elsevier Canada.
1. What are three types of suctioning and when is each used?
i) oropharyngeal
ii) nasopharyngeal
iii) nasotracheal
2. What does the nurse need to assess
i) before initiating suctioning?
 O2 Sats, checking equipment, check client
ii) after suctioning?
 O2 Sats
3. What are the risks involved in suctioning?
Hypoxia, trauma, pain, bradycardia
4. What factors normally influence upper or lower airway functioning?
Absent cough, recent surgery of chest or abdomen, presence of respiratory disorders, alterations in chest
anatomy, heart failure, neuromuscular blockade, poor diaphragmatic movement, accumulation of
respiratory secretions, dehydration, presence of respiratory infection, lack of humidity
5. Why would the nurse:
i) suction the oropharynx before the oral cavity or, in the case of endotracheal or tracheal suctioning,
insert the catheter through the nasal passages and suction the trachea before pharyngeal area?
 The mouth and pharynx contain bacteria that can potentially contaminate the trachea. If
necessary, suction the mouth with a different suction catheter / yanker prior to beginning this
procedure.
ii) wear a mask or face shield?
 In case anything splashes or the client spits back at you
6. Why are the following guidelines important?
i)
do not suction for more than 10 seconds without releasing negative pressure:
 You can induce hypoxia or cause pain
ii) assist the client to sit upright or in semi-fowler’s position:
 To allow for easy breathing for clients and help expand airways when breathing
iii) What factors normally influence upper or lower airway functioning?

Absent cough, recent surgery of chest or abdomen, presence of respiratory disorders, alterations
in chest anatomy, heart failure, neuromuscular blockade , poor diaphragmatic movement ,
accumulation of respiratory secretions , dehydration , presence of respiratory infection , lack of
humidity
iv) set the vacuum regulator pressure before beginning suctioning:
 To ensure that the vacuum works and at a regular rate before placing it into the client
v) know how to choose the right size airway and insertion method:
 To ensure that over-suctioning doesn’t occur and that you don’t damage the patient’s airways.
vi) introduce the catheter during client inhalation:
 To ensure easier placement of the suction catheter
7. When suctioning via an artificial airway, why would the nurse do the following?
i) collaborate with a respiratory therapist:
 They have a more intimate knowledge of the respiratory system and can assist with special cases
or other
ii) ensure the client gets extra oxygen before suctioning:
 To lower the incidence of hypoxia for the client
iii) insert the suction catheter until it presses gently against something or the person coughs, then draw
the catheter back 1cm or 1/2 inch before suctioning:
 To ensure that the catheter is far enough in the airway, but that you’re pulling back so that it isn’t
too far. This gives the catheter wiggle room in case a client moves
TRACHEOSTOMY CARE
Harvey, G & McLean, H., (2019). Chapter 39. Cardiopulmonary functioning and oxygenation. In P. A.
Potter, A. G. Perry, P. A. Stockert, A. M. Hall, B. J. Astle, & W. Duggleby (Eds.), Canadian fundamentals
of nursing (6th Canadian ed.). Milton, Ontario, Canada: Elsevier Canada.
1. What is the definition of tracheostomy and when would this surgical intervention be done?
tracheostomy is a medical procedure — either temporary or permanent — that involves creating an
opening in the neck to place a tube into a person's windpipe. The tube is inserted through a cut in the
neck below the vocal cords. This allows air to enter the lungs.
2. Why is surgical asepsis so important in tracheal care?
Due to the trach, bacteria can easily enter the airway without any barrier preventing them from entering.
3. When should tracheostomy care be performed?
Routinely, at least once a day depending on wound site, drainage, and discharge
4. There are 2 types of inner cannulas used in tracheostomies. What would be the advantage of
a disposable inner cannula?
Disposable cannulas have a lower chance of having bacteria on them due to being brand new and don’t
require cleaning beforehand.
5. Why would it be advisable to have an assistant while changing tracheostomy ties?
Trach care is easier with two people since the aseptic technique can be difficult with one pair of hands
6. Why is it imperative to have a back-up tracheostomy set up at the bedside at all times?
In case the trach is dropped or no longer aseptic, or if the first trach is moved or causing issues