The rationale of assessment of a patient with a chest tube is to ensure the swinging, bubbling, the draining and the vital signs are within the accepted normal. However, these are not the only assessed in a patient with a chest tube. The others assessed in this patient include…
345). Depending on the condition of the patient, monitoring should be either continuous or intermittently. Bubbling and swinging are assessed with the patient’s respiration. In normal respiration, the fluid within the tube rises with inspiration and falls with expiration (Paul and Williams, 2009 p.45). Absence indicates that the tube is blocked, or it is out of the pleural space. Intermittent bubbling in the water seal chamber shows an air leak when the patient coughs or exhales. Continuous bubbling indicates air leak between the patient and the drain. Volume, color and consistency of the drainage are monitored (Smeltzer et al., 2010, p. 234). The drain insertion site is also assessed for signs of infection and inflammation. The sutures are checked if they are intact and secure and that the dressing is clean and intact (Smeltzer et al., 2010 p. 252).
The rationale for clamping the chest drain is to reduce the risk of tension pneumothorax. Smeltzer et al., (2010 p. 252) recommend disconnection of the chest drain in the case of sunction or the patient are ambulant. However, during the transport, the chamber should be kept below the patient’s chest level to enable draining (Smeltzer et al., 2010, p. 123). This allows gravity drainage and prevents backflow of fluid. However, Paul and Williams (2009, p. 13) suggest that clamping can also be done when the drainage bottle requires a replacement or to locate any air leak in the drainage system. Therefore, the suggestion that chest drains should only be removed when the patient is to be moved is false.
If the water in the chest tube was—swinging but not bubbling or draining it means the air has been removed from the pleural space but that the pneumothorax has not resolved. When bubbling initially stops this should be further assessed by instructing the patient to cough.
When monitoring for the patient with chest pneumothorax the bubbling shows the presence of air in ...
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