CHEST TUBE DRAINAGE

INTERCOSTAL DRAINAGE

1. CHEST TUBE DRAINAGE [PLEUR EVAC]

2. Intercostal drainage is the insertion of a tube into the pleural space to evacuate air/ fluid, to help regain negative pressure and thus promote lung expansion.

3. Clinical need for chest drainage : When negative pressure in the pleural cavity is disrupted by the presence of air and/or fluid resulting in pulmonary compromise. The purpose of a chest drainage unit is to evacuate the air and/or fluid from the chest cavity to help, re-establish normal intrathoracic pressure

4. INDICATIONS Pneumothorax Closed o pen

5. Hemothorax

6. Chylothorax Pleural Effusion

7. Empyema Cardiac tamponade

8. Post operative cardiothoracic surgery Mechanically ventilated patients with any size of pneumothorax / haemothorax Respiratory distress or ventilator dependence that does not permit thoracentesis .

9. PRINCIPLES

10. EQUIPMENT   A sterile flexible silicone or vinyl catheter. The proximal end of the tube has several eyelets (small holes) to drain air and fluid & prevents catheter from becoming occluded. A radiopaque stripe assists the verification of placement on x-ray for maximum efficiency.

11. SIZE OF THE CHEST TUBE The unit of chest tube size is French sizing, which refers to circumference in millimeters. According to the age, Adult Male = 28-32 Fr Adult Female = 28 Fr Child = 18 Fr Newborn = 12-14 Fr

12. CHEST DRAINAGE SYSTEM- TRADITIONAL

13. COMPARTMENTS

14. TUBE PLACEMENT Pneumothorax - At the second or third ICS on the mid- clavicular line or mid- axillary line. Size 16 to 24 Fr.

15. Haemothorax - At fourth to eighth (usually sixth to eighth) ICS on the mid- clavicular or mid- axillary line. Size 28 to 36 Fr.

16. Both air and fluid the two chest Catheters can be joined externally with a Y-connecter. Mediastinal chest tubes are inserted to remove air and blood following cardiac surgery or chest trauma.

17. ADVANCEMENTS IN CHEST TUBE DRAINAGE

18. WET SUCTION CONTROL SYSTEM

19. WET SUCTION CONTROL   Traditional chest drainage units regulate the amount of suction by the height of a column of water in the suction control chamber. In wet suction control system [Pleurevac], fill the suction control chamber to the desired height with sterile fluid. Connect the short suction tubing to a suction source , and adjust the source suction to produce gentle bubbling in the suction control chamber.  

20. DRY SUCTION CONTROL

21. DRY SUCTION CONTROL The dry suction units are controlled by a self-compensating regulator . A dial to set the suction control setting is located on the upper left side of each unit. To set the suction setting, rotate the dial until the red stripe appears in the semi-circular window at the prescribed suction level and clicks into place. In the presence of a large air leak , air flow through the Pleur-evac may be increased by increasing source suction.

22. ADVANTAGES OF DRY SUCTION SYSTEMS Higher suction pressure levels can be achieved, Set-up is easy No continuous bubbling, provides for quiet operation No fluid to evaporate which would decrease the amount of suction applied to the patient.

23. ONE WAY VALVE SYSTEM- GRAVITY

24. ONE-WAY VALVE In the Pleur-evac Sahara , a one-way valve replaces the traditional water seal. No water is required to establish the one-way seal. Just connect the patient tube to the patient’s thoracic catheter and the patient seal is established for patient protection. It works with the gravity support. It has an airleak monitor.

25. SPICTRA- Chest / Thoracic Drain System 1-2 Litres capacity , disposable, automatic overflow capacity with multiple chambers.

26. COMPLICATIONS Chest tube malpositions Re expansion pulmonary edema Infection of the skin site Pneumonia Shoulder disuse (frozen shoulder) High negative pressure due to The patient in respiratory distress, coughing vigorously, or crying Chest tube stripping Decreasing or disconnecting suction

27. NURSING CONSIDERATIONS RESPIRATORY STATUS Are there signs of respiratory distress or a change from the baseline respiratory assessment? CARDIAC STATUS(MEDIASTINAL TUBES) Are there signs of cardiac tamponade ?

28. CHEST TUBE INSERTION SITE Is dressing clean, dry, and intact? Is there crepitus upon palpation around the site? Has the thoracic catheter been pulled out of the chest? PATIENT DRAINAGE TUBES Are all connections securely taped or banded Is the tube patent and free of kinks? Are there any dependent loops in the tube? Is the clamp open?

29. COLLECTION CHAMBER What is the character of the drainage; is it bloody, straw colored , or purulent? What is the rate of drainage? Has the drainage stopped suddenly? Are the columns only partially filled? Is the collection chamber full?

30. WATER SEAL CHAMBER Is the water level correct at 2 cm? Is the negative pressure indicator (YES) visible? AIR LEAK METER Is there bubbling? Is the bubbling continuous or intermittent? If there is no bubbling, does the fluid move up and down with respirations? Has water risen in the small arm of the water seal/air leak meter?

31. WET SUCTION CONTROL Is there continuous bubbling? Is the chamber underfilled or overfilled? DRY SUCTION CONTROL Is the dial set at the prescribed suction? Is the orange float present in the indicator window? Does the water rise in the small arm of the air leak meter when the dry suction setting is lowered? GRAVITY DRAINAGE Is the suction tube/port open?