Chest Tubes in the Newborn Escape Game

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Chest Tubes in the Newborn Escape Room

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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:

• 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.

Introduction

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

Missions

Final Mission

Mission 4

Mission 3

Mission 2

Mission 1

Mission 1

Yes

No

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

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

Missions

Final Mission

Mission 4

Mission 3

Mission 2

Mission 1

Mission 2

Respiratory Distress Syndrome

Pneumothorax

Meconium aspiration

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?

1/3

Mission 2

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?

2/3

Hemothorax

Mission 2

All of these

Chylothorax

Tension Pneumothorax

3/3

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

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

Missions

Final Mission

Mission 4

Mission 3

Mission 2

Mission1

Place him prone, propped up on shoulder rolls

Mission 3: Assisting the Provider

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

Place him supine with his arms above his head

1/3

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

Mission 3: Assisting the Provider

Yes, the picture is correct

No, the picture is incorrect

2/3

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?

Prior to insertion

After insertion

They do not need pain medication for this procedure

Mission 3: Assisting the Provider

3/3

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

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

Missions

Final Mission

Mission 4

Mission 3

Mission2

Mission1

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

Connect drainage system to patient’s thoracic catheter.

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

Mission 4: Chamber Setup

1/8

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

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

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

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

Mission 4: Chamber Setup

2/8

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?

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

Connect drainage system to patient’s thoracic catheter.

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

Mission 4: Chamber Setup

3/8

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

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

Connect drainage system to patient’s thoracic catheter.

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

Mission 4: Chamber Setup

4/8

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

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

Connect drainage system to patient’s thoracic catheter.

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

Mission 4: Chamber Setup

5/8

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

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

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

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

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

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.

F. Connect drainage system to patient’s thoracic catheter

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

Mission 4: Chamber Set-up

Solution

Solución

continue

6/8

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

Sudden increase in drainage collection chamber

Occlusive dressing with no drainage noted

Tidaling with respirations

Mission 4: Chamber Set-up

7/8

Which assessment finding requires further action?

Mission 4: Chamber Set-up

True

False

8/8

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.

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

Missions

Final Mission

Mission 4

Mission3

Mission 2

Mission1

The collection chamber

The suction regulator

Check the tubing, starting closest to the patient

Mission Five: Troubleshooting

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

1/3

d. When air leak is noted

c. When repositioning the patient

a. When changing the collection chamber unit

b. Per physician order

g. A and B only

Mission 5: Troubleshooting

f. All of the above

e. When stripping chest tube

Well done!When should you clamp the chest tube?

2/3

This Statement is True

This Statement is False

Mission 5: Troubleshooting

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!

3/3

3/3

3/3

3/3

Start over?

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

Completed

Oh oh!

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

That answer is not correct...

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