Policy Manual sample

MDT Home Health Care Agency, Inc. G. If the chest tube is to suction, and there is an order to ambulate the patient, ascertain if the physician has ordered in SCM (in the Chest Tube insertion order set) for the patient to go to water seal. If no order present, contact physician to obtain an order to remove the patient from suction and put them to water seal. H. To change the Pleur-evac, review new equipment and assemble as previously stated. Clamp each chest tubes with two (2) clamps and quickly change the system. NOTE: Clamp for 10 seconds or less and no longer than one minute to prevent a tension pneumothorax. * Change system at clamp closest to system approximately six (6) inches from Pleurevac. I. Any dependent loop of tubing containing fluid will obstruct flow and create back pressure, especially to an air leak. Simply coil the tubing flat on the bed and let it run directly down to the bottle. J. The open air vent must be either open to room air or connected to working suction machine. K. Assess patient for pain and medicate as needed (ordered). Encourage deep breathing, range of motion exercising and comfort. L. If alert, enlist patient's cooperation to call if short of breath, bleeding, or other changes appear. Skin Assessment The insertion site should be regularly checked for any skin breakdown or subcutaneous emphysema (SCE). SCE can occur when air or CO2 is trapped in the subcutaneous tissues, and frequently occurs on the face, neck, or chest. A physical assessment will reveal edema of the affected area along with subcutaneous crepitus (crackling sensation under the skin during palpation). While palpating the involved area, use a skin marker to identify its borders. This will help you determine whether the SCE is progressing or resolving. In most cases, the affected tissues slowly absorb the SCE after the underlying cause is identified and treated. When reabsorption occurs, air can move from the insertion site into the face, chest or neck and may displaced the chest tube. Air under the skin is usually painless, and feels spongy; some people describe it as feeling "Rice Krispies" under the skin. If it becomes painful, the physician should be notified. Patient Assessment The patient and the chest drainage unit require additional monitoring while the chest tube is in place. Depending on the patient's condition, a nurse should check the chest tube and monitor it at least once every 8 hours or more (depending on the patient’s condition). Patient assessment is foremost and should concentrate on: • Vital signs • Respiratory rate • Respiratory status • Respiratory pattern • Respiratory depth • Ease of respiration • Oxygen saturation • Check for subcutaneous emphysema (crackling sensation under the skin during palpation) Signs of respiratory distress include tachypnea, dyspnea, shortness of breath, tachycardia, decreased or absent breath sounds, and use of accessory muscles of respiration. Monitoring the Chest Drainage Unit Monitoring the chest drainage unit is important to make sure it is functioning correctly. When monitoring the unit, it is important to regularly check: • Water levels in the chest drainage unit. The water may evaporate over time, and may need to be refilled periodically. • The connection source to ensure that the chest drainage unit is suctioning properly. Adequate Home Health Agency Nursing Care & Procedures K-214