Care of client with chest tube

chest tube care

1. Care of Client with under water seal drainage

2. Chest tube is a flexible plastic tube that is inserted through the side of the chest into the pleural space to reexpand the lung.

3. Purpose It is used to remove air , fluid or pus. To establish normal negative pressure in the pleural cavity for lung expansion. To equalize pressure on both sides of the thoracic cavity. To provide continuous suction to prevent tension pneumothorax.

4. Indication Pneumothorax : accumulation of air Pleural effusion: accumulation of fluid Chylothorax : a collection of lymphatic fluid Empyema : a pyogenic infection of the pleural space Hemothorax : accumulation of blood Hydrothorax : accumulation of serous fluid

5. Contraindication Bleeding diathesis Coagulopathy

6. Pre Procedure Confirm the procedure Inform patient Check for the consent Prepare the equipments X-ray (with the report to determine the affected lung) Position patient

7. During the procedure Observe/monitor patient’s Respiration Saturation Reduce patient’s anxiety Prepare the under water seal Connect the closed system fast

8. Post procedure Monitor vital signs 15min x 1 hour 30mins x 1 hour 1 hour x 4 hours and until stable Take note of the respiration Rate Pattern Rhythm Check saturation Administer oxygen when necessary

9. Post procedure 1. Care of patient Respiratory status Auscultates lungs to assess air exchange in the affected lung Place patient in fowler’s position

10. 2 . Care of the wound Change the gauze when necessary Strict aseptic technique when performing dressing Check skin integrity Redness Swelling Loose suture

11. 3. Care of the Tubing Intact and taped Maintain patency Check for obstruction Teach patient on how to take care of the tubing Place a pillow between patient and tubing Coil the tube Avoid dependent loop Instruct patient to cough if tube is blocked Milking and stripping of the tube when blocked

12. 4. Clamps Use rubber tips Clamped at the bedside Clamping During transfer Not more than 1 minute Upon doctor’s order Note: clamping chest tube will accumulate in the pleural cavity since the air has no means of escape. This can rapidly lead to tension pneumothorax .

13. 3 principles of under water seal Gravity Water seal Suction

14. 5. Water seal Enhances flow from high to low. Place below patient’s chest wall (gravity) Fill with sterile water. Rod must be immersed 2cm in water. Observe for the fluctuation of water level.

15. 5(a) Fluctuation To ensure the patency of the system It will stop when : lung fully expanded an obstruction Check for obstruction Tubing –kinked Patient’s position Ask patient to take a deep breath and cough

16. 5(b) Bubbling Intermittent bubbling : normal Continous bubbling : abnormal Check : Wound Tube Connection If rapid bubbling without air leak : inform doctor immediately

17. 5(c) D rainage output 70-100 mls per hour observe for any change in drainage colour Mark the amount Document in I/O chart Change bottle every 24hours or when full

18. 6. Suction apparatus Low suction pump Must be controlled Suction valve / meter is inserted for wall suction Check for bubbling If no bubbling Clamp chest tube to check for air leaks Check tubing and connection Observe patient’s condition while chest tube is clamped.

19. 7. Safety 1. Tube Prevent kinking Place a pillow as barrier Never clamp unnecessarily 2. Bottle Must be below chest Keep bottle in basin Inform relatives and housekeeping

20. 8. Ambulation Encourage patient to change position to promote drainage No need to clamp the tube Maintain chest tube below chest wall

21. 9. Exercise Encourage deep breathing and arm exercise. On the first post op day. When patient not in severe pain. Assist patient. To enhance the lung expansion Prevent stiffness of the arm

22. 10. Comfort Administer analgesic in the first 24hours. Allow position that comfortable to the patient . Assist patient in daily living activity Hygiene

23. Removal of chest tube Assessment X-ray done to check the progress Clamp for 2 h ours Chest tube removed

24. Emergency care Bleeding Observe wound dressing Observe drainage Dislodgement From insertion site : place a gauze immediately From connection : clamp chest tube immediately

25. Emergency care… Bottle breaks Identify either patient having pneumothorax or hemothorax . Observe patient for tension pneumothorax. Place tube in saline immediately. Unclamped immediately. (prevent respiratory distress) Elevation of bottle Immediately inform doctor

26. Complication Bleeding Pulmonary embolus Cardiac tamponade Atelectasis