Participant name (Print):



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|ST. JAMES HEALTHCARE |

|Butte, Montana |

Medical Surgical & Monitored Unit Nursing Competency Validation

PARTICIPANT CHECKLIST

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|CHEST TUBES |

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|Skill |Critical Behavior |Achieved |

|1. Infection |Verbalizes hand hygiene as a first step. |( Yes |( No |

|Control / |Verbalizes appropriate use of personal protection (sterile gloves, gown and face / eye protection). | | |

|Personal |Verbalizes appropriate disposal of sharps and body fluid waste. | | |

|Protection | | | |

|RATIONALE: |Review of the following rationale - SJH Policy |( Yes |( No |

|(for #1) | | | |

|2. Patient |Verbalizes Universal Guidelines and SJH Standard (MD order, Procedure Consent and Time Out |( Yes |( No |

|Safety | | | |

|RATIONALE: |Review of the following rationale - SJH Policy |( Yes |( No |

|(for #2) | | | |

|3. Set up & Preparation|Demonstrates and / or verbalizes the following steps: |( Yes |( No |

| |Remove drain from sterile packaging, swing out floor stand and set on flat surface. | | |

|Of Atrium Dry Suction |Slide Tube Clamp to where the tubing enters the drain. | | |

|Chest Tube |Fill waterseal to 2 cm line with pre-packaged sterile water (through blue suction port located on top of the drain). | | |

| |Place drainage collection unit below the level of the patient's chest. | | |

| |Verify regulator control dial located on the side of the drain is auto set [– 20 cm]. | | |

| |Increase / decrease regulator control (typically - 20cm H2O, but may vary based on MD order). | | |

| |Sterile drain tubing (distal) end is connected to the chest tube. | | |

| |Suction tubing attachment from wall is connected to chest drain (blue outlet). | | |

| |Adjust suction level source until the orange monitor bellow expands to the white arrow mark (at least 80 mm Hg for | | |

| |desired water suction of – 20 cm H20). | | |

| |Add / remove water from sterile fluid from water seal or suction control chamber; clamp tubing prn and use ≤ 20 g. | | |

| |needle) | | |

| | | |

|Skill |Critical Behavior |Achieved |

|RATIONALE: |Review of the following rationale: |( Yes |( No |

|(for #3) |H2O seal prevents air from entering pleural cavity. | | |

| |Placing below chest prevents backflow of air/fluid. | | |

| |Regulator control dial determines amount of suction pressure, NOT adjustments on wall gauge. | | |

| |Dial down to lower and up to increase the suction pressure. | | |

| |(SJH Policy: Infection Control) | | |

| |Suction source can be regulated or unregulated wall vacuum or electric suction pump. | | |

| |Triangle ^ mark determines minimum distance for bellows to engage suction pressure of - 20 cm H2O. | | |

| |Momentary pinching off suction tubing is needed to assess fluid levels and to add fluid; and < 20 g. preserves tubing | | |

| |patency. | | |

|4. Securing |Demonstrates and / or verbalizes: Connection secured with non porous tape, i.e. silk (parallel / spiral strips at top |( Yes |( No |

|Connection |and bottom). | | |

|RATIONALE: |Prevent accidental disconnection of chest tube from collection unit and prevents air from entering the system. The |( Yes |( No |

|(for #4) |connection is a common place for a clot to form (non-porous tape with some visibility helps). | | |

|5. Patient Assessment |Demonstrates and / or verbalizes the following steps: |( Yes |( No |

|& Monitoring |Assess presence of an air leak by observing the water seal chamber for air bubbles. | | |

| |Assess for fluctuation (“tidaling”) in water seal chamber which reflects chest pressure change with breathing (is not | | |

| |an air leak). | | |

| |Patient teaching to perform valsalva maneuver / deep breathe. | | |

| |Assess tubing for clots and / or kinks If continuous air leak suddenly stops, and notifying the MD. | | |

| |Assess location of a new air leak in the water seal chamber by starting at top of patient tubing: clamp tube and see if| | |

| |air leak stops or continues and unclamp the tube. | | |

| |Testing for leaks (i.e. if air leak or bubbles stops when the tube is clamped then the leak is located above the clamp;| | |

| |if leak continues, then the leak is located below the clamp). | | |

| |Assess tubing patency by clamping at intervals moving down. | | |

| |Measures and documents output in appropriate EMR location. | | |

|RATIONALE: |Review of the following rationale: |( Yes |( No |

|(for #5) |Air leak indicates air escape from lung into pleural space and air leak should gradually decrease/resolve over time. | | |

| |This phenomenon is normal and is referred to as tidaling. | | |

| |Coughing or valsalva maneuver provides an increase in pressure during expiration - allowing the air to be expelled. | | |

| |Sudden stop in continuous leak may indicate clot or kink in tubing and put patient at risk for pneumothorax. | | |

| |New air leak may indicate new lung injury or a leak within the system. | | |

| |Air leak in the system may alter function. Leak needs to be found and resolved OR the system may need to be changed. | | |

| |The connection site is the most likely source of a non-pathologic air leak. | | |

| | | | |

| |Ensures air/fluid is removed from the chest. | | |

| |To determine suction D/C and plan removal of the chest tube. | | |

| | | |

|Skill |Critical Behavior |Achieved |

|6. Patient Transport |Demonstrate and / or verbalize the following steps: |( Yes |( No |

| |Obtain portable suction device and TURN ON portable device. | | |

| |Change suction from wall device to portable device. | | |

| |Adjust suction level appropriately. | | |

| |Changing from suction to gravity drain (keeps clamp open). | | |

|RATIONALE: |Review of the following rationale: |( Yes |( No |

|(for #6) |Maintain suction according to the MD order. | | |

| |Portable device will provide suction for transport, but will only last 45m. Make sure to transfer from portable to wall| | |

| |suction ASAP. | | |

| |Restore suction and make sure to adjust suction level until the orange monitor bellows expand to the white arrow mark. | | |

| |Preparing the patient for ambulation or transport. | | |

|7. Changing |Demonstrate and / or verbalize the following steps: |( Yes |( No |

|Atrium drain system |Set up new unit according to MD orders. | | |

| |Disconnect patient tubing on new unit and discard. | | |

| |Place new unit next to old unit. | | |

| |Ask patient to hold his/her breath; briefly clamp chest tube | | |

| |Switch patient tubing to new unit by disconnecting at distal site closest to Atrium and reconnect to new unit at same | | |

| |site, using sterile technique. (OK to fold/clamp tubing in your hand to prevent spillage or if patient unable to follow| | |

| |instructions). | | |

| |Unclamp chest tube. | | |

| |Instruct patient to breathe again. | | |

|RATIONALE: |Review of the following rationale: |( Yes |( No |

|(for #7) |SJH Standard Order Set | | |

| |Tubing disconnection and proximity to new drain set will change at the distal site. | | |

| |Holding the breath prevents air from entering the pleural space. | | |

| |Quickly switching units using sterile technique helps to reduce risk of infection. | | |

| |H2O seal will prevent air from entering the chest. | | |

| |Communication with the patient is essential during critical steps. | | |

|8. Changing |MD order required to change mode from suction to water seal. |( Yes |( No |

|Mode | | | |

|RATIONALE: |Review SJH Policy; MD is tracking I & O & CXR order to determine if it’s safe to discontinue suction. |( Yes |( No |

|(for #8) | | | |

|9. Dressing |Chest tube site - occlusive foam tape / Vaseline gauze dressing. |( Yes |( No |

| |Change dressing q 24 hrs or PRN (MD PERFORMS) | | |

|RATIONALE: |Prevent air from being drawn into the pleural cavity, reduces risk of ongoing pneumothorax (note: currently performed |( Yes |( No |

|(for #9) |by MD on Med-Surg) | | |

| |Prevent infection and irritation/excoriation. | | |

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|Participant name (Print): _____________________ Validator name: (Print) _______________________ |

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|Date: ___________ Unit:ICU □ ED □ MED SURG □ Passed: Successfully □ Retake required □ |

References: Atrium University - Oasis Chest Drain System

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