Chest tube drainage

1. Prepared by Ms. Mahalakshmi.L M.Sc. Nursing 1 st year CHEST TUBE DRAINAGE

2. What Is Chest Tube? A chest tube is a catheter inserted through the thorax to remove air and fluids from the pleural space, to prevent air or fluid from re- entering the pleural space, or to Re-establish normal intrapleural and intrapulmonic pressures

3. Chest Tube

4. Indications : Pneumothorax Hemothorax Pleural Effusion

5. purposes 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.

6. contraindication Bleeding diathesis Cardiac temponade Coagulopathy atelectasis

7. size of chest tube Adult male – 28-38fr Adult female – 28fr Child – 18fr Newborn – 12-14fr

8. Confirm the procedure Inform patient Check for the consent Prepare the equipment X-ray Position patient Pre procedure

9. during procedure Observe/monitor patient’s respiration , saturation. Reduce patient’s anxiety. Prepare the under water seal. Connect the closed system fast

10. 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

11. Sites for chest tube insertion Thoracic surgery Anterior chest Posterior chest tube pneumothorax

12. How A Chest Drainage System Works: Expiratory pressure from the patient helps push air and fluid out of the chest (cough, Valsalva Manuer) Gravity helps fluid drainage as long as the chest drainage system is below the level of the chest Suction can improve the speed at which air and fluid are pulled from the chest

13. Types Of Chest Drainage Systems The most commonly used drainage systems are: One bottle / single bottle system Two bottle system Three bottle system

14. One Bottle / Single Bottle System

15. One Bottle / Single Bottle System The simplest closed drainage system is the single chamber unit. The chamber serves as a fluid collector and a water seal. During normal respiration the fluid in the chamber ascends with inspiration and descends with expiration. This is used for smaller amounts of drainage such as an empyema

16. Two Bottle System

17. Two Bottle System The use of two chambers permits any fluid to flow into the collection chamber as air flows into the water-seal chamber. Fluctuations in the water-seal tube are anticipated. Two chambers allow for more accurate measurement of chest drainage and are used when larger amounts of drainage are expected.

18. Three Bottle System

19. Restore negative pressure in the pleural space Chest tube will be connected to a suction through 3 bottle system that maintains negative pressure in the pleural space

20. Three Bottle System When a volume of air or fluid needs to be evacuated with controlled suction, all three chambers are used. Mark the suction control with centimeter readings to adjust the amount of suction. Usually 15 to 20 cm of water pressure is used for adults

21. Pleuro Vac

22. Pleuro Vac

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

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

25. 3.Care of chest tube 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

26. 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.

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

28. 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

29. 5(b) Bubbling Intermittent bubbling : normal Continuous bubbling : abnormal Check : Wound , Tube Connection If rapid bubbling without air leak : inform doctor immediately

30. 5(c) Drainage output 70-100 mls per hour observe for any change i n drainage colour . Mark the amount  Document in I/O chart  Change bottle every 2 4 h r s w h e n f u l l

31. 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.

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

33. 8.Ambulation Encourage patient t o change position to promote drainage No need to clamp t h e tube Maintain chest tube below chest wall

34. 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

35. 10.Comfort  Administer analgesic in the first 24hours.  Allow position that comfortable to the patient .  As s is t patien t i n dail y living activity  Hygiene

36. Removal of chest tube  Assessment  X-ray done to check the progress  Clamp for 2 hours  Chest tube removed

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

38.  Bottle breaks Identify either patient having pneumothorax or hemothorax . Observe patient for t e ns io n pneumothorax. Place tube in saline immediately. Unclamped immediately. (prevent respiratory distress)  Elevation of bottle  Immediately inform doctor