The Basics of Chest Tube Management

The basics about managing patients with chest tubes! 📝 Free Quiz: adv.icu/3g6HseX
💲✂️ 10% off EACH Month your MyNurisngMastery subscription: adv.icu/mastery
❤️🙏🏼 Show your support with an ICU Advantage Sticker HERE 👉🏼 adv.icu/support
For this lesson we are now past the foundational information on how chest tubes and breathing works as well as covering the different disorders of the pleural space. We now are focusing on the actual management of the patient with a chest tube. In this lesson I cover some of the important information from our assessment that we do for the patient, as well as the chest tube, its draining, dressing and the whole system. I also cover a couple of important topics to understand when I talk about the air leak and the tidaling that we can see, what they mean, and what we need to do, if anything. I also hit on the potential emergency situation where the tubing becomes disconnected as well is if the chest tube becomes dislodged or pulled out. This is a longer lesson with a lot of good information that will cover the nuts and bolts when it comes to the management of the patient with a chest tube.
----------
🤔 Curious how you can show your support? AND get extra content such as the notes for each lesson!
Consider supporting ICU Advantage....
- on KZbin channel membership head over to: adv.icu/ym
- on Patreon head over to: adv.icu/pm
If not, no worries, as you watching videos here, liking them, commenting and sharing them also really help to support the channel! 😍
---------
👕 $20 towards Figs Scrubs! adv.icu/figs 🤑
LIMITED TIME OFFER! Get 3 free stocks valued up to $6300 by opening & funding a Webull brokerage account! Get started: a.webull.com/wfFpxIPmW3jyn7pnaA
---------
📚📖BOOKS I RECOMMEND
✔️Barron’s CCRN Exam: amzn.to/2MFWIkH
✔️Pass CCRN!: amzn.to/36apxgN
✔️AACN Essentials of Critical Care Nursing: amzn.to/2F5riQs
✔️Kaplan Adult CCRN Review: amzn.to/37igv1t
✔️Marino’s The ICU Book: amzn.to/2ZzKP4Y
🩺🏥🖊SOME OF MY FAVORITE NURSING GEAR
✔️3M Littmann Master Cardiology Stethoscope: amzn.to/2sn0wR5
✔️Rip Shears - Trauma Shears: amzn.to/35diZwR
✔️Leatherman - Raptor Shears: amzn.to/2MGF801
✔️Stethoscope Tape Holder: amzn.to/2snWkAy
✔️Pilot FriXion Erasable Pens: amzn.to/2Qw9pQg
💻🎙GEAR THAT I USE TO MAKE THESE VIDEOS
✔️Apple Pencil: amzn.to/368qS83
✔️iPad Pro 12.9”: amzn.to/367s2QV
✔️Blue Yeti Mic: amzn.to/2Q7vrK9
✔️MacBook Pro 15”: amzn.to/2tcDegM
👍🏼👍🏼👍🏼
If you enjoyed this video or found it useful, please hit the like button as this greatly helps the channel out! Also make sure and subscribe, hit the bell icon and select all notifications to stay up to date on our latest videos!
👁🎥👁🎥
Check out these other great lessons and series of lessons below!
✅ Hemodynamics: • Hemodynamic Principals
✅ Shock: • Shock
✅ ECG/EKG Rhythm Interpretation: • ECG/EKG Interpretation
✅ ICU Drips: • ICU Drips
✅ ECMO: • ECMO
✅ CRRT: • CRRT Explained!
🙏🙏 A Special THANK YOU to KZbin and Patreon Members!!! 🙏🙏
🏆 Patreon Code Team: John, Tsz, Dajana, Selena, Anita, Amelie, Dominic, April!
0:00 Intro
2:16 Assessment of Patient
3:25 Drainage
5:41 Dressing
7:23 Insertion Site
10:09 Position of CDU
10:30 Tidaling
12:47 Air Leak
17:04 Suction
18:05 Tubing
19:29 Sampling of Drainage
20:25 Dislodgment of CT
23:07 Maintenance
27:09 Wrap-up
⚠️⚠️ DISCLAIMER: Links included in this description are affiliate links. If you purchase a product or service with the links that I provide I may receive a small commission. There is no additional charge to you!
❗️❗️PLEASE NOTE: ICU Advantage medical videos, medical lectures, medical illustrations, and medical animations are for medical education and exam preparation purposes, and not intended to replace recommendations by your doctor or health care provider. The information is present here to give you a starting place to further look in to the proper treatments and recommendations for the care of your patient.
#ICUAdvantage #ChestTubes #Management

[@ICUAdvantage]

❤🙏🏼 Show your support with an ICU Advantage sticker! 👉🏼 adv.icu/support Notes for this lesson (and all previous lessons) are availably only to KZbin and Patreon members. Links to join both here ⬇ ► KZbin: adv.icu/ym | ► Patreon: adv.icu/pm

[@bigjosh1215]

Currently have a chest with this system attached, was looking for more information so I can be more proactive on my situation. Very helpful, thank you for explaining in detail.

[@titilayooluyori2527]

All I can say is thank you! This is the best chest tube video out there.

[@goharali2162]

Your lectures are not only comprehensive but also very easy to understand and memorise with practical examples.

[@andreawong5225]

Thank you,Eddie. Your teaching is so thorough and easily understood. It's live saving not only to patients but to everyone who listens to you.

[@ICUAdvantage]

If it can help even just one person, then its more than worth the effort! Fortunately I also enjoy making them too so its a win win 😊

[@kenkunzelman6385]

What a great lesson! Thank you. You are very much appreciated, please keep up the thorough and detailed work. These videos have not only helped my confidence in the MICU but helped maintain integrity, save time and most likely save lives.

[@ICUAdvantage]

Wow thank you so much for this comment Ken. Really happy to hear these videos have been so helpful for you. Thats truly my goal is to give people the tools and help make things click so they can be applied out there with patients where it matters.

[@kassiehowe]

Your channel is awesome! I went back to nursing after a 10 year break and these videos have helped tremendously!! Thank you so very much!!

[@ICUAdvantage]

Glad to hear this and they have been helpful for you. And welcome back Kassie!

[@greensahuaro2834]

Thanks for the thoroughness of the subject. Thanks for keeping it objective.

[@christalkong9744]

Very clear and concise lecture - amazing work!!! :)

[@GuiFalked]

As a leaky spontaneous pneumothorax patient living in a rural location where it appears home care nurses aren't generally versed in management of said tubes I have to say thanks for such clearly detailed information on the steps involved in general care of the system. Now to figure out how to keep the dogs out of my lap 😊

[@stevenr5149]

I love the examples of common issues that might happen and the interventions that need to be done(If…then). Keep up the great work.

[@ICUAdvantage]

Great to hear Steven. Glad you found those helpful!

[@rjj6887]

Been waiting for this content. Thank you.

[@ICUAdvantage]

Hope you liked it!

[@Ex2Pookie]

As a med surg nurse on Respiratory floor this is the best lesson ever👏🏾👏🏾

[@alexisjoseph9843]

Very thorough, thank you!

[@cassandregousse4792]

Great nuggets of wisdom in this lesson! Thanks for covering these topics! I’ve always wondered about milking the CTs vs. not doing so and Xeroform dressings vs. plain 4x4s. This was a great review!

[@ICUAdvantage]

Thank you! I was really happy with how this lesson, and series came out. Really glad you were able to get some good nuggets from this one.

[@destinyrivera6659]

Every facility I have been at does not allow stripping or milking of tubing. I started a new job and my preceptor said we have to but I had to ask the educator if that is how we are suppose to be doing it because I am uncomfortable lol

[@ssutter5280]

Very educational!

[@abdullahoz1]

Very nicely done! Very informative! Thank you!!

[@ICUAdvantage]

Glad you enjoyed it!

[@rayanmalih6854]

Really good video, thank you.

[@sarahlothspeich6675]

ER nurse educator here, I love your content!! Thanks for the video!

[@ICUAdvantage]

Very cool! Yeah definitely a lot of stuff on this channel applies with you guys as well. Glad you enjoy the videos!

[@anitarenitaa5833]

/

[@goharali2162]

I love this channel.❤❤❤

[@nononana2539]

Really thank you

[@meumentorgringo8342]

Great video. Thx.

[@mirandahannah4343]

Coming to you live from my night float rotation in residency, got a question about an air leak from a nurse that I had to learn about. Great lesson, very helpful!

[@ICUAdvantage]

Very cool! Hope you found what you were looking for!

[@abrahamrumayara743]

Thank you so much. Very helpful.

[@ICUAdvantage]

You're very welcome!

[@han4691]

Great info!! Thank you!

[@ICUAdvantage]

Truly my pleasure. Glad you enjoyed it!

[@sarcomere1]

Awesome! Learned a few things!

[@ICUAdvantage]

Great! I feel like I'm always learning something new which is why I love making these.

[@ghiix2758]

Amazing work thanks👍🏻💕💕💕💕

[@ICUAdvantage]

Appreciate that!

[@Melikeshomer23]

Great lesson! 👍

[@ICUAdvantage]

Thanks Raul! Went on longer than I was expecting, but had a lot to talk about lol

[@superwoman2607]

Thank you for this video.

[@ICUAdvantage]

You're welcome!

[@skeome]

I currently have a chest tube in due to spontaneous pneumothorax. It's always nice to know if there's something wrong so I can notify my nurse or cna

[@MA-wo5yk]

Love this channel! I would have liked to hear you touch on what happens if wall suction is too low (

[@ICUAdvantage]

Glad you enjoy the channel. If wall suction not at least -80, then the proper suction will not be delivered to the CT and you will effectively have either decreased suction or even no suction, aka water seal.

[@Thehungrytravelers]

Very helpful!

[@ICUAdvantage]

Glad to hear it Bri! 😊

[@kamenslaveev1821]

Thank you!

[@ICUAdvantage]

You're welcome!

[@oguzkagan5905]

Ellerinize emeklerinize yüreğinize sağlık Süper 💯💯💯💯💯

[@timothyramsey590]

master Eddie!!!!

[@DoeintheThicket]

Could you let me know what the procedure is for transporting a patient with a chest tube? For example, if/when/where to clamp for the trip and what to do if you’re taking them to an area (like a scan or procedure) where they are not set up to reestablish wall suction? Thank you. Adding pt transport considerations to these topics would be so helpful. ❤

[@tnijoo5109]

I want to know too.

[@deniseross4432]

Thank you 💓

[@ICUAdvantage]

You're welcome Denise!

[@JacintoEspeleta-iq3bb]

Best of the best !!!!!

[@ICUAdvantage]

Awesome!!

[@nyawirawaithaka4993]

thank you!

[@ICUAdvantage]

You're welcome!

[@ryankelly5303]

Thank you.

[@ICUAdvantage]

You're welcome

[@stormyfisher8796]

Thanks!

[@ICUAdvantage]

Thank you so much for this!

[@ghiix2758]

I’m a 3rd year Respiratory therapy student, i hope you can make a video of the Mechanical Ventilation basics and so on✨ Love your channel literally informative and great source👍🏻

[@ICUAdvantage]

I've got a whole playlist for that! kzbin.info/aero/PL2oVjKTYocdOLnrAhciLL4S3bPr6e_e3q Glad you enjoy the videos here and find them helpful!

[@ghiix2758]

@@ICUAdvantage wow THANKSS

[@quillegas]

Thank u!

[@ICUAdvantage]

You're welcome!

[@kayodus34]

Thank you

[@ICUAdvantage]

You're welcome!

[@jacobmadigan45]

Do burns next please!

[@emart7729]

Thanks for these videos! I do have two questions... 1. If it is a new chest tube after lung surgery with no bubbling in water seal, this is normal? I was still a little confused about that part after your video. 2. I was told by a colleague that bubbling in water seal during inspiration is also bad. is this because it should only be on expiration; similar to your blowing through a straw analogy?

[@JessiBrat]

I recently had to have a chest tube inserted after I was stabbed in the lung and it calapssed. Having a chest tube is very painful while it's in! I was bed bound for 3 days afterwards. I had to be on morphine and oxycodone. I felt so much better after it was removed.

[@Katthenurseee]

Hi there, can anyone tell me why we would choose a dry drainage unit over a wet one?

[@rand0mGT]

Pressure release valve…at what level do we bring it back down when it’s too high?

[@francyelefonseca1512]

Ty for this lesson!! 💕 when you mention bubbling, whether it be continuous/intermittent “initially” being normal in a pneumothorax; how long is initially? I’m sure there are other factors as well, but just to have a general idea, thanks again! Very informative

[@ICUAdvantage]

Glad you enjoyed it. To answer your question, it really just depends on the size of the pneumothorax. It could have bubbling pretty consistently within the first hour and then slowing down after that. Hard to give an exact answer though as it truly just depends. It should be improving over time which is the biggest indicator.

[@jessicag8208]

Great lesson using the Atrium Oasis. The hospital I now work at only uses the Atrium Ocean. Can you add a little info/drawing of that setup to the video?

[@ICUAdvantage]

Unfortunately once uploaded, no way to add anything to the video. I also have never personally used the ocean. I feel like I saw it once years ago, but I've always just used the dry suction Oasis. It should just be a matter of additional additional fluid to the far left chamber. I can't speak to if theres adjustment you can make for different suction levels or if it actually requires different levels of water though.

[@aquriajohnson9512]

Hi! I love your content. I am a new member who just joined here on KZbin. Where/how do we access the notes for each video lesson?

[@ICUAdvantage]

Hey Aquria! First off thank you and I really appreciate your willingness to show me and this channel your support! As for the notes, if you go to the main ICU Advantage KZbin page and then look for the "Community" tab, that is where I post the links each week to the lessons before they release publicly. In that post, there will be a link to the lesson notes and the password for the month. Let me know if you have any issues.

[@moradzayed]

thanks

[@ICUAdvantage]

You're welcome!

[@creamsoda4441]

Sorry, would like to ask why tidaling stop if there is re-expanded lung?? Thank u!!

[@shanekaervin6733]

Great video, when do you plan on making a Mid-sternum chest tube?

[@ICUAdvantage]

I do have mediastinal chest tubs on the todo list for some time in the future

[@Lauracupcake1121]

When setting up, I see some people set up a suction canister and some set it up directly to the wall suction. Is there a difference?

[@eduardodiaz9354]

Unfortunately milking is ordered by providers specifically the MCT CT surgeons will rather let you milk it than getting a tamponade great lesson 👍

[@ICUAdvantage]

Yup! Hence why I still hit on it. Glad you enjoyed the lesson.

[@akanchhakhadka3860]

Diuretic use please

[@JohnnyWishbone85]

I'd really love to get my hands on a chest tube system to test its functionality in an ambulance. I transport people with them fairly regularly, and I'm always concerned about large bumps in the road disturbing the seal.

[@ICUAdvantage]

They will work just fine. The seal is mechanical and they can move around without impacting this.

[@peoplearewater]

Thank you so much for your video! When you say pinch the insertion site, do you mean the actual skin of a client? Also, can you do a tutorial on how to measure bladder pressure using the A line set up?

[@ICUAdvantage]

Yes, pinch the skin around the insertion site trying to see if you can stop the air leak. Like pinching in towards the CT from the outside skin on both sides. And I do plan on covering bladder pressure. Got it on the todo list.

[@peoplearewater]

@@ICUAdvantage Awesome! I look forward to your video. Btw, I completed my capstone project on TTM, and now I have a degree😎 Thanks for your introduction🙌

[@ICUAdvantage]

@@peoplearewater yaas!!! Congratulations!

[@peoplearewater]

@@ICUAdvantage Thank you❤

[@rand0mGT]

Petroleum gauze as in xeroform right? Is Vaseline gauze same as xeroform? What’s occlusive dressing mean? Is that same as petroleum gauze?

[@ashsilos7252]

😂 my adhd had to pause the video and spend 20 minutes to figure out why "cm" was pronounced "sonometer". to find out it's actually centimeters but people started pronouncing it as sonometers because that's how the french say it or they just copied how everyone else around them say it. why does my brain go to things that are completely irrelevant?! But other than that... This was a great video. Thanks a lot.

[@stevenrogers4663]

Eddie, I am sure this has been asked before, what program/software do you use to create your lectures?

[@ICUAdvantage]

Hey Steven. haha, yeah it has! I use Adobe Photoshop that I screen cast to an iPad. Just screen record with Quicktime.

[@trendyinsta42]

Love ...

[@ICUAdvantage]

Thank you!

[@aliagak]

Can you address the suction control chamber when the patient chest tube is to wet suction and not dry suction? I've seen the water in that chamber evaporate rather quickly due to the wall suction. What happens if the chest tube is to wall suction and the suction control chamber is empty?

[@ICUAdvantage]

I wish I had more experience with wet suction to speak to. I can say if it runs dry then whatever suction is set at on the wall will transfer to the patient so could lead to very high suction to the patient and potential injury.

[@andrearatkovic4048]

I had a patient who had six chest tubes (3 bilaterally) during the early months of first Covid. He eventually expired. Pneumothraces kept appearing, and this was how they were addressed. Just wondering, though, if anyone has had any experience w/multiple CTs (say, over 2) and what the outcomes were.

[@ICUAdvantage]

Specifically for ARDS/COVID, its certainly not great if recurrent pneumothoraxes or pleural effusions keep popping up. In other situations, such as trauma, multiple chest tubes can be common.

[@aalemohammadsyed1949]

I recently attended a patient in ICU who had unresolving PTX after insertion of a single CT. At day 6, a second CT was inserted but the lung didn't expand. Patient was on ventilator and was unfit for any surgery or bronchoscopy. Cardiothoracic surgeon advised differential lung ventilation, so a double lumen endobronchial tube was inserted. Although it was successfully inserted, the patient eventually expired.

[@stephaniesilva3230]

Can you explain the dry suction, set suction, water seal...how do I categorize the chest tube?

[@jljordan1]

In front of the chest tube will say what it is typically….

[@lucasa4955]

This might be a dumb question, but when transporting these patients what is the best/EBP way of doing so? Is there a difference in transporting a pneumo vs effusion?

[@lucasa4955]

I ask because we would normally disconnect suction to transport, but I’m curious if there is a difference in transporting the two

[@armandogarcia1862]

typically a nurse or a licensed person who knows how to manage a CT should go with them. it has a water seal so itll prevent that air going back in and gravity will pull yhe fluid out

[@iheartsleeppeace8973]

I'm a member through KZbin, but how can I access the notes on patreon, without paying again??

[@iheartsleeppeace8973]

Nevermind, I scrolled down to a similar comment

[@ICUAdvantage]

Ok glad you found it and thanks so much for your support. I will say I really wish KZbin made it easier for everyone to find the content!

[@carme4614]

I cannot see the notes I do not have a password

[@ICUAdvantage]

If you go to the “community” tab, look for the most recent post with the link to the Dropbox and the password for the month. It does change each month. Let me know if you are still having issues finding it and thank you so much for your support!

[@heatherlee9780]

Anyone else having trouble with this playing?

[@ICUAdvantage]

Might just be internet connection. It plays fine for me and I've heard no issues.

[@gracewaithaka9382]

Thank you

[@ICUAdvantage]

Youre welcome!

[@dovewc3]

Thank you

[@ICUAdvantage]

You're welcome