Chest Tubes in the Newborn Escape Game

Chest Tubes in the NewbornEscape Room

start

Introduction

• Learner will be able to verbalize the indication for chest tube placement.
• Demonstrate the correct steps to position the patient and assist with chest tube placement.
• Demonstrate the correct set-up for the chamber.
• Verbalize troubleshooting the chest tube drainage system.

You’ve been assigned chest tube set-up and maintenance, you will need to finish each mission to successfully complete this task and escape! At the end of your mission, you will have achieved the following objectives:

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Education Resources: Chest Tubes in the NICU presentation - found in your HealthStream module or on your competency resource online folder Dynamic Health Assisting with Chest Tube Insertion in Newborns Chest Tube Care in Newborns Chest Tube Removal in Newborns

Mission 1

Mission 2

Mission 3

Mission 4

Final Mission

Missions

Complete each mission: there is no other way to escape!

1

Icebreaker question:You've read the objectives and have the resources. Are you ready?

No

Yes

Mission 1

Mission 1

Mission 2

Mission 3

Mission 4

Final Mission

Missions

Complete each mission: there is no other way to escape!

1/3

You are taking care of a 39.0 male patient, born approximately 60 minutes ago. He received PPV via bag-mask ventilation immediately following delivery for low heart rate. He is presenting now with sudden, severe respiratory distress, unequal breath sounds, and increasing O2 requirements. Based on this limited history, what do you suspect?

Meconium aspiration

Pneumothorax

Respiratory Distress Syndrome

Mission 2

2/3

Pneumothorax occurs when air enters the intrapleural space, restricting normal lung expansion. The removal of that air is accomplished through needle aspiration. There is not always time for an x-ray to confirm pneumothorax prior to needle aspiration. Which picture shows a pneumothorax identified by transillumination?

Mission 2

Chest tubes are not just for removing air from the intrapleural space. What other conditions require chest drainage?

3/3

Tension Pneumothorax

Chylothorax

All of these

Mission 2

Hemothorax

Mission1

Mission 2

Mission 3

Mission 4

Final Mission

Missions

Complete each mission: there is no other way to escape!

When positioning the patient for chest tube insertion, you know you should:

1/3

Place him supine with his arms above his head

Place him on his side, affected side up, with anterior arm raised

Mission 3: Assisting the Provider

Place him prone, propped up on shoulder rolls

An orientee asks why some chest tubes are located in different areas of the chest. You give the explanation pictured below, is this the correct answer?

2/3

No, the picture is incorrect

Yes, the picture is correct

Mission 3: Assisting the Provider

The ideal time to administer pain medication to the infant having a chest tube placed is:

3/3

Mission 3: Assisting the Provider

They do not need pain medication for this procedure

After insertion

Prior to insertion

Mission1

Mission2

Mission 3

Mission 4

Final Mission

Missions

Complete each Mission: there is no other way to escape!

You have just opened the drainage system package to setup the chest tube. What is your next step?

1/8

Mission 4: Chamber Setup

Adjust Dry Suction Regulator, per clinician order, usually between -5 and -20 cm H2O.

Connect drainage system to patient’s thoracic catheter.

Fill Water Seal using sterile needleless pre-filled syringe to the 2 cm line. Once filled, water turns blue.

You correctly filled the Water Seal and the fluid has turned blue. The thoracic catheter has been inserted in the patient and the drainage system connected. What is the next step?

2/8

Mission 4: Chamber Setup

Adjust Dry Suction Regulator, per clinician order, usually between -5 and -20 cm H2O.

Connect the unit to wall suction (if ordered) via the suction port.

Turn on suction and visually confirm the orange bellows appears in the window. Adjust wall suction until it appears.

The drainage system has been connected to the wall suction. What is the next step?

3/8

Mission 4: Chamber Setup

Adjust Dry Suction Regulator, per clinician order, usually between -5 and -20 cm H2O.

Connect drainage system to patient’s thoracic catheter.

Turn on suction and visually confirm the orange bellows appears in the window. Adjust wall suction until it appears.

The wall suction has been adjusted and the orange bellows is visible in the window. What is the next step?

4/8

Mission 4: Chamber Setup

Adjust Dry Suction Regulator, per clinician order, usually between -5 and -20 cm H2O.

Connect drainage system to patient’s thoracic catheter.

Fill Water Seal using sterile needleless pre-filled syringe to the 2 cm line.

The wall suction has been adjusted and the dry suction have both been adjusted per provider's orders. What is the next step?

5/8

Mission 4: Chamber Setup

Place drain below patient’s chest, with the swivel stand on the floor or hang below bed with multi-position hangers.

Connect drainage system to patient’s thoracic catheter.

Fill Water Seal using sterile needleless pre-filled syringe to the 2 cm line.

To review the setu-up, place these interventions in order. Drag in place.

6/8

1

2

3

4

5

continue

Solución

Solution

Mission 4: Chamber Set-up

6

7

G. Turn on suction and visually confirm the orange bellows appears in the window. Adjust wall suction until it appears.

F. Connect drainage system to patient’s thoracic catheter

E. Fill Water Seal using sterile needleless pre-filled syringe (attached to the back of the unit) to the 2 cm line. Once filled, water turns blue.

D. Open and set up drainage system per manufacturer’s instruction.

C. Connect the unit to wall suction source (if ordered) via the suction port. Wall suction should be set at -80 to -100 mmHg.

B. Place drain below patient’s chest, with the swivel stand on the floor or hang below bed with multi-position hangers.

A. Adjust dry suction regulator, per clinician order, usually between -5 and -20 cm H2O

1 - D 2 - E 3 - F 4 - C 5 - G 6 - A 7 - B

Which assessment finding requires further action?

7/8

Mission 4: Chamber Set-up

Tidaling with respirations

Occlusive dressing with no drainage noted

Sudden increase in drainage collection chamber

When managing two or more chest tube systems, you should label each chamber with #1, #2, etc, to ensure I/O accuracy. You should also assess the status of each collection chamber individually.

8/8

False

True

Mission 4: Chamber Set-up

Mission1

Mission 2

Mission3

Mission 4

Final Mission

Missions

Complete each Mission: there is no other way to escape!

1/3

You note bubbling in the air leak chamber. Where should you check for the source of the air leak?

Mission Five: Troubleshooting

Check the tubing, starting closest to the patient

The suction regulator

The collection chamber

2/3

Well done!When should you clamp the chest tube?

e. When stripping chest tube

f. All of the above

Mission 5: Troubleshooting

g. A and B only

b. Per physician order

a. When changing the collection chamber unit

c. When repositioning the patient

d. When air leak is noted

3/3

3/3

3/3

3/3

You're almost there! Your orientee asks when it is okay to press the negative relief valve. You respond that it should only be pressed if the applied vacuum level is decreased to a lower setting OR if stripping the tubing results in increased negativity. You also point out that if suction is not on, pressing the valve could reduce the pressure in the collection chamber to zero, resulting in pneumothorax!

Mission 5: Troubleshooting

This Statement is False

This Statement is True

Completed

Congratulations, you have ESCAPED!!!Code Word: DRYoasis

Start over?

back

That answer is not correct...

But don't lose your balance, continue on your way and try again!

Oh oh!