Intercostal drainage tube insertion

Definition, indication, parts, types, procedure, NR

1. Intercostal Tube Insertion Dr. Uttpal Desai ( Senior Surgeon ) Mr . Mahesh Chand ( Nursing Tutor)

2. Definition Inter costal water seal drainage system is insertion of tubes into the pleural cavity with attached drainage system so as to remove air, blood or fluid from the pleural cavity.

3. Tube and Bag Size Varies from 6 to 40 Fr .

4. Purpose To remove air, blood or fluid It promotes re-expansion of lung.

5. Indication Pneumothorax Heamothorax Thoracotomy Chest surgery Chest trauma

6. Principles Related To Close Chest Drainage System Gravity - fluid from a higher level to lower level. Therefore, always keep the chest drainage apparatus below the level of person’s chest. Positive pressure – air or fluid in the chest cavity creates positive pressure in the pleural space. This is because air moves from higher pressure to lower pressure created by water seal. Suction – A pull force of less than atmospheric pressure creates a sub atmospheric pressure.

7. Types of chest drainage Single bottle water seal system Two bottle system Three bottle system

8. Preparation of Patient Explain the procedure. Keep the patient in fowler’s position Reassure the patient and allay all his/her doubts and fears

9. Preparation of Articles Sterile tray containing: Sterile chest tube of an appropriate size Sterile drape Gloves mask, cap, gown Syringe and needle for local anesthesia Lignocaine 2% Cleaning articles Betadine Gauze Adhesive plaster, tincture benzoin A mackintosh with towel screen

10. Procedure Explain the procedure (Reduce anxiety) Assist the surgeon with the insertion of chest tube Connect the chest tube to water seal drainage

11. After care of patient and articles Stay with the patient till he/ she is at ease. Keep the patient comfortable. Observe vital signs and drainage. Check the chest wall wound is sealed well. Take all the used articles to the utility room.

12. Nursing responsibility Observe the Chest tube dressing Observe the Tubing for kink, clots for maintains a patent, freely draining system. Chest drainage should be upright and below the level of tube insertion. Observe for Water seal for fluctuations with patient’s inspiration and exertion. Fluid rise on inspiration and falls with expiration, indicating proper functioning of the system.

13. Observe for bubbling in water seal bottle/ chamber. Ensure drainage tube in water seal 2.5 cm below the water level. Ensure that 2 tubing clamps are always at the patient bed side. Maintain a high fowlers position . Maintain all connection between chest and drainage tubes intact and taped. Wash hand every time whenever handle the tube.

14. Precaution to be taken while replacing the chest drainage bottles Assemble the bottle with tight stopper and tubes and check for functioning. Double clamp the chest catheters close to the patient’s chest to prevent entry of air into pleural cavity. Clamps are applied at the end of full inspiration to prevent the air being sucked into pleural space .

15. Disconnect the bottle is placed to be replaced along with the drainage tubing and attach new set. Unclamp the patient chest catheter and make sure that the system is functioning properly before leaving the patient. Watch the patient vital signs for few minutes to see any changes in general condition .

16. Bibliography Annamma Jacob, Rekha R, Jadhav Sonali Trachand “clinical nursing procedures: the art of nursing practice, second edition, Jaypee publication: 2011, pg.no 436-437 Sr . Nancy, “principles and practice of nursing”, Senior nursing procedures, volume two, N.R publishing house: 2005 Pg. no 201-205 Trained nurses association of India, “fundamentals of nursing a procedure manual”: first edition-2005,Published by secretary-general Pg. no- 513-516 Brunner and Suddarth’s textbook of medical surgical nursing, eleventh edition, Published by Wolters Kluwer Pg. no 816