Care of Chest Tubes

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Care of Chest tubesClosed Chest Drainage System

VN 255


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Thora-centesis: chest-puncture

Insertion of a needle into the pleuralspace to aspirate fluid (pleural

effusion=fluid trapped pleural space)aspirate/or drain fluid, blood, air, or toinject medication. May be for (diagnostic-reasons), or for therapeutic reasons to

reduce respiratory distress If a continuous drainage is required use a

chest drainage system like a Pleur-Evac

closed chest drainage system.


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Thoracentesis:

After this procedure: Physician applies

petroleum-jelly based gauze over the

insertion site and forms a tight occlusivedressing. Monitor VS, changes in

respirations/SOB and a CXR post procedure

to be sure the lung was not punctured during

the procedure causing a pneumo-thorax orcollection of air or gas trapped in pleural

space=lungs to collapse!


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At the bedside: Always keep 2 padded

clamps- may be needed if the chest tubes

accidentally become dislodged/disconnected

from the tubing.

Pleur-Evac system is the new modern closed

drainage system that has evolved from older3-bottle system..works on same principle:

1=drainage collection bottle ( fluid/blood)

2=water seal bottle***** most important

3=suction bottle ( only if you need suction)

otherwise suction chamber is left open or

vented to allow air escape.


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Closed-chest drainage system


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3 bottle system: Suction bottle,Water-seal bottle,

Drainage bottle


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Closed-Chest drainage System

Pleur-Evac drainage system A thoracentesis is preformed usually at

bedside/surgery and a chest drainage system

(Pleur-Evac) system is hooked up to allow forcontinuous drainage of either air, blood, or

fluid. Often it is an Emergency situation

If goal is to remove air?- upper anterior chest,

2-4 intercostal space (catheter is inserted)

If goal is to remove fluid/blood?-lower lateral

chest 8-9 intercostal space (catheter inserted)


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Chest Drainage System

Pleur-Evac System Once the tube/catheter is secure in the

pleural space (by M.D.), nurse hooks up

the Pleur-Evac system. Make sure allconnections are secure (use adhesive

tape to prevent a break in the system)

and sterile petroleum- jelly basedocclusive gauze/ dressing are applied

over insertion site to prevent air leaks!


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Closed Chest Drainage SystemPleur-Evac chest drainage system

The whole system is based on maintaining aNegative intra-thoracic pressure so we need

a water seal bottle/chamber ( bottle # 2)

Each time client exhales=air is trapped inpleural space and it travels down the chest

tube to water seal bottle/chamber under

water and then bubbles up and out of the

bottle! The water acts as a seal allowing air toescape from pleural space but preventing air

from getting back into the lungs via negative

pressure of inspiration!


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Water seal bottle/chamber The water level in the water seal

bottle/chamberwill fluctuate gently up anddown with each inspiration/expiration. This is

called tidaling

Only time tidaling should stop is 1.= when thelung is re-inflated and no longer requires a

chest tube or

2.= if a problem occurs with the tubing

(kinked, occlusion, breaks in the system) andshould be checked ASAP!

3.=Ifconstant or vigorous bubbling occur

please check for a leak something is wrong


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Closed Chest Drainage System Suction bottle/chamber (bottle #3) used to

speedily re-inflate the lungs. Water is added tothe bottle/chamber. Suction is applied. (theforce of suction is solely dependent on amountof water in bottle not the amount of suction seton suction machine. If water evaporates=addmore water to prescribed level of water.

See gentle bubbling in suction bottle

If vigorous bubbling=suction will not be

maintained; did the water evaporate? Addprescribed amount.

If suction not used: chamber is then left opento allow air to escape.


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Closed Chest Drainage System: Drainage/Collection bottle/chamber (#1)

Only used if drain fluid/blood pleural space.(pleural effusion, chest trauma, surgery).Drainage chamber is not emptied but justmarked amount every shift on thebottle/chamber.

Report any marked increases in bloodydrainage/fluid. Recorded as Output

Often when chamber is full; RN/M.D. willchange out the closed chest drainage system(Pleur-Evac) with a new one.


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Closed Chest Drainage System General guidelines:

Check system for any breaks,cracks, kinks intubing, or broken connections Auscultate lung sounds, any sudden SOB, dyspnea,

pain, hear any crepitous sounds= think SQemphysema? hear & palpate for leakage of air into

SQ tissue Tight occlusive dressing intact? Clamps at

bedside?

No dependent loops tubing? Is the drainage

system below chest level?

Check water seal chamber and or suctionchamber for the correct amount of water inchambers? Any vigorous bubbling? leaks?

Record drainage as output

Cl d d i


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Closed drainage system If client must be transported: suction is

usually off and air is vented out. Tubing is

not clamped for transport! If a tube accidentally pulls out=quickly place

a tight occlusive dressing over the insertionsite on the chest to prevent air from re-

enteringfollow hospital policy Process of Milking and Stripping tubes is

controversialfollow hospital policy

If time to D/Cd the Chest tube/closed

drainage system= M.D. pulls tube out andtight occlusive petroleum-jelly based gauzeis applied over insertion site: CXR done(check for pneumothorax d/t a puncture

lung?) Monitor respirations & for crepitous?

Care of Chest Tubes

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