Fundamentals - Practice & Skills, part 28: Chest Tubes, Artificial Airways, Tracheostomy Care, Home Oxygen Safety
by Meris Shuwarger BSN, RN, CEN, TCRN August 20, 2021 Updated: June 16, 2022 5 min read
Hi. I'm Meris. And in this video, we are going to be talking about chest tubes, artificial airways, tracheostomies, and home oxygen safety. I'm going to be following along using our Fundamentals of Nursing flashcards. These are available on our website, leveluprn.com. If you already have a set, I would invite you to follow along with me. I'm starting on card number 136. Let's get started. So first up, let's talk about chest tubes. This may not be something that's covered in your program for fundamentals, but it is for some students. So big things to know is about the drainage system, the collection device itself. There's kind of like three important chambers to be paying attention to. The first is the drainage collection, where the actual fluid or air is being collected. We have so much bold and red text here. I would say really, really pay attention to it. But we do have here to report drainage greater than 100 milliliters per hour to the provider.
Now, we have two others that I want to talk about kind of together. One is the water seal chamber, and one is the suction control chamber. Water seal is what provides the airtight seal for the chest tube, and suction control is where the actual suction is controlled if it is hooked up to wall suction. Now, in the water seal chamber, it's normal to see tidaling. Tidaling is when the fluid level kind of moves up and down with the patient's respirations. That's normal. That's okay. What is not okay is continuous bubbling. A bubble here or there in the water seal chamber is okay, but continuous bubbling indicates a leak. In the suction control chamber, however, continuous bubbling is expected.
All right. So moving on to nursing care of chest tubes. You'll see here a lot of information. This is card 137. We have so much information on here. A lot of it I'm going to let you explore in your own time. But one of the things that I want to point out is if we saw continuous bubbling in the water seal chamber, or if the chest tube itself were to become disconnected from the collection device, well, now, it's open to the air. So what we need to do is put the end of that tube into sterile water or saline, immediately, and then call the provider. Remember, when we ask about the priority action, it's if I could only do one thing. And if I could only do one thing, it would be to restore that seal. Remember, too, that a chest x-ray is needed to confirm placement of the chest tube. And then we also want to make sure we don't clamp the tube. We never clamp the tube, unless it is ordered. And we don't milk or strip the tube, meaning we don't use our hands to mechanically move fluid towards the collection device. The collection device should also be kept flat on the floor. It should be below the patient's chest. And we do need to keep it flat because if it tips, we're going to end up not being able to track how much output is coming from that patient.
Let's move on to artificial airways. So we have a few on here that I'm going to hit on, oropharyngeal and nasopharyngeal. Oropharyngeal, right here. Nasopharyngeal, right here. These are sometimes called adjunct airways. They are not securing the airway. They are not going into the trachea. But what they are doing is providing kind of a pathway for air to go when we use a bag-valve mask. So if we need to bag the patient because they're not breathing adequately, or at all, then we want to have an adjunct airway. Keep in mind, I need to lubricate anything that's going in the nose with water-soluble lubricant. And the oral adjunct should be inserted upside down and then twisted into the correct position. And that's going to keep the tongue in place, also.
Now, an endotracheal tube, endo meaning inside, tracheal meaning trachea, in the trachea, this is actually the true artificial airway that is going into the trachea and allowing us to deliver oxygen directly to the lungs. This is sometimes called an ET tube. We also have a tracheostomy tube, and it's the same idea. It's going into the trachea, trachea ostomy, tracheostomy. Remember, an ostomy is a surgically created opening, so it's a surgically created opening in the neck that allows us to put an airway into the trachea itself. It's shorter. It's less irritating for the surrounding structures, so this is better for patients who require long-term ventilation.
All right. So let's talk now about tracheostomy care. Very important things on this card. Some big, bold, red text that I want to hit on as well. Definitely defer to whatever you're being taught or whatever your facility policy is for trach care, but something I want to point out is that we always clean from the stoma outward. Remember, this is kind of similar to how we do wound care. We are not introducing bacteria to the site. And tracheostomy care in the hospital, by a registered nurse, should be done with sterile technique. Patients who care for their own tracheostomies at home very likely use clean technique, but don't let that confuse you. You, as a nurse, need to be using sterile technique. When we put split gauze-- there's split gauze. It's gauze that is split down the middle, and it kind of allows us to slide it up under the tracheostomy. We must use pre-split gauze. Do not cut gauze yourself because that creates lint and fuzz.
All right. This is the biggie. Home oxygen safety. This is one of those cards that I would say star it. Put a sticker on it. Do something so you know, "I've got to know everything on this card." This is so important because patient safety comes before all else, and keeping our patients safe at home is our responsibility as well. So home oxygen safety, no smoking. Post No Smoking signs in the house and outside of the house. Keep the oxygen tank upright and housed securely. So don't lay it down. Don't prop it up. That's important. Use water-based lubricants. We've talked about that before. And wear cotton clothes, cotton clothes, not synthetic fabrics because these can create sparks which, in theory, could then lead to a fire. Another thing that I want to mention about home oxygen safety is about the fraying of electrical cords. So we need to make sure that if we have frayed electrical cords that they are repaired or replaced because, again, sparks can lead to fire.
I hope this review was helpful for you. If it was, please go ahead and like this video so that I know you enjoyed it. If you have a awesome story to tell me or a great way to remember something, I really want to hear it in the comments, so please tell me. I hope you've subscribed to the channel by now because we have so much incredible content coming your way. I have one more video in the practice and skills playlist for you, and this is going to be about perioperative nursing care. So I hope I will see you there. Thanks so much, and happy studying.
True story, my grandma had No Smoking signs posted in her home and outside of her home. She didn't use home oxygen, though, so she might have just been neurotic. But yeah, so people actually do post them.
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