CHEST TUBES AND DRAINAGE SYSTEMS NURSING COMPETENCYPresented by: Jonna Bobeck BSN, RN, CEN

OBJECTIVES

Discuss anatomy and physiology of chest

Describe mechanics of breathing Explain indications/contraindications Discuss nursing care Describe set up and monitoring Understand water seal

INTRODUCTION

ANATOMY OF THE CHEST

Ribs

Intercostal Muscles

Lung

Visceral Pleura

Parietal Pleura

WHY ARE THE LUNGS EXPANDED

MECHANICS OF BREATHING

INDICATIONS: PNEUMOTHORAX/HEMOTHORAX

INDICATIONS: TENSION PNEUMOTHORAX

INDICATIONS: OTHER CONDITIONS

CONTRAINDICATIONS AND CAUTIONS

Be aware of hemodynamic status Use of a trocar Pneumothorax and air transport

HOW WATER SEAL CHEST DRAINAGE UNITS FUNCTIONS

FLUID COLLECTION

WATER SEAL

Safe Cost effective Measurement of

intrathoracic pressure

SUCTION CONTROL

EQUIPMENT

PREPARATION AND INSERTION

IV, O2, Monitor Proper cleansing Place patient supine Administer antibiotics Prepare drainage device Tape or band connections Apply occlusive dressing Obtain CXR Monitor

FOUR STEP SET UP: STEP 1

STEP 2

STEP 3

STEP 4

WHAT TO CHECK DURING SYSTEM OPERATION: SUCTION CONTROL STOPCOCK

WHAT TO CHECK CONTINUED

Verifying system operation Placement of unit

PLACEMENT OF UNIT

Place below patient’s chest Use floor stand or hangers

OBSERVING FOR AIR LEAKS

SAMPLING PATIENT DRAINAGE

OBSERVING CHANGES IN PATIENT PRESSURE

HIGH NEGATIVITY FLOAT VALVE

MANUAL HIGH NEGATIVITY VENT

WHAT TO CHECK CONTINUED

Positive pressure protection Adding water to water seal Adding water to suction control Suction greater than -20cmH20 How to lower suction control pressure setting Recording drainage volume

IN-LINE PATIENT TUBE CONNECTORS

PATIENT TUBE CLAMP-

GRAVITY DRAINAGE AND SYSTEM DISCONNECT

Placement Stopcock Close slide clamp

AUTOTRANSFUSION CAPABILITY

WARNINGS AND PRECAUTIONS

Colleceted blood should not remain in chest drain for more than 6 hours

Keep patient tube clamp open during operation

Purge all air/do not administer entire contents

Citrate toxicity Use a microemboli filter Use hangers Maximum infusion pressure 150 mmHg

SET UP ATS COLLECTION Close chest drain ATS access line clamp and remove spike

port cap. Insert ATS bag spike into access line of chest tube drainage system.

Position ATS bag below the base of the chest drain. Open both clamps. Holding ATS bag below base of chest

drain, bend ATS bag upward where indicated and it will pop open. Do not activate ATS bag prior to connecting chest drain.

When drainage has been collected Close ATS access line and ATS blood bag clamps.

Remove spike from ATS access line and recap ATS access line spike port and position access line in the holder located on top of the chest drain.

Keep ATS clamp fully closed at all time when not in use.

ATS BAG REINFUSION SET UP

Prime I.V. blood administration and microemboli blood filter with sterile saline.

Invert ATS bag with spike port pointing upward and remove cap using sterile technique.

Insert saline filter spike into ATS bag spike port.

Return bag to upright position and place on standard height I.V. pole.

TROUBLESHOOTING GUIDE

How to confirm airleak Floatball is at the bottom of water seal

column Lowering water seal level Water rises to the top of the water seal float

valve Tidaling of pressure ball

TROUBLESHOOTING CONTINUED

No bubbling in the suction control chamber Vigorous bubbling noted in the suction

control Should suction control valve be turned off for

transport? should the manual vent be used during

gravity drainage? What to do if drainage system gets knocked

over

UNEXPECTED OUTCOMES

Air leak Mediastainal shift Tube dislodgement Substantial increase in bright red drainage Loss of suction Crepitus

DOCUMENTATION

Patient and family education Reason for tube Assessment Presence of fluctuation and bubbling Amount of suction Patient tolerance

OMG! LOOK AT THAT OUTPUT!

REFERENCES Atrium Medical Corporation, Initials. (2010). A personal guide to

managing chest drainage. New Hampshire: Atrium Medical Corporation.