Chest tubes and oxygen delivery devices

Device items ask whether you understand the plumbing. Tension pneumothorax recognition lives in Acute respiratory emergencies. Chronic COPD oxygen targets live in Respiratory chronic disease. This chapter owns chest-drainage chambers and oxygen delivery hardware.

Chest tube drainage: three chambers

A chest tube pulls air or fluid out of the pleural space so the lung can re-expand. The drainage unit is a one-way system: stuff leaves the chest and should not go back. Knowing which chamber is talking keeps you from treating a normal finding like an emergency — or missing a real leak.

Tidaling means pressure in the chest is still communicating with the water seal — usually reassuring. Tidaling that stops may mean the lung re-expanded, or the tube kinked/clotted — look at the client before you celebrate. Continuous bubbling in the water seal is different from gentle bubbling in suction control: seal bubbles are the leak hunt; suction bubbles are often how wet suction proves it is working.

• Keep the drainage system upright and below the chest.
• Do not routine-clamp for transport unless protocol says so — clamping can turn a leak into a tension pneumothorax.
• Secure connections; petroleum/occlusive supplies ready per protocol if the tube dislodges.
• Mark drainage at shift change; report sudden floods of bright blood or abrupt stops with distress.

Two emergencies look similar until you name the broken piece. If the drainage tubing disconnects from the unit, a common protocol parks the open chest-tube end briefly in sterile water to recreate a water seal while you rebuild a sterile system — follow facility steps, do not clamp as a first reflex. If the tube pulls out of the chest, cover the site with an occlusive dressing per protocol (often taped on three sides so air can vent), stay with the client, watch for tracheal deviation and crashing SpO2, and get help. New bright-red drainage flooding the collection chamber after chest surgery is a bleed pathway — vital signs and notify beat tidy charting.

Oxygen delivery devices

Pick the device that matches how much FiO₂ and control the stem needs. Low-flow comfort is not the same as an emergency reservoir mask. Devices do not replace an airway — if the client cannot breathe, escalate beyond a cannula argument.

Why Venturi exists: some clients need a known FiO₂ so you do not overshoot into CO₂ retention territory while still treating hypoxia. Color-coded adapters set the percent — match the order, keep the ports clear, and do not “turn it up like a cannula” when the stem wants precision. Why the non-rebreather bag must inflate: the reservoir is the oxygen stockpile; set flow high enough (often 10–15 L/min as taught) so the bag stays inflated and the mask seals. A flat bag means the client is mostly rebreathing room-leaning gas.

Hypoxic COPD clients still get oxygen — titrate to the ordered saturation band rather than withholding O₂ from fear. The distractor that looks ‘COPD-safe’ is leaving SpO₂ at 78% because ‘they’re retainers.’ Edge case: facial trauma or claustrophobia may block a mask seal — choose an alternative that still delivers ordered oxygen while you escalate. Noninvasive ventilation (CPAP/BiPAP) supports selected failure pictures only when the airway is protected and vomiting risk is managed — it is not a substitute for intubation when the client is crashing and aspirating.

Priority map