Care Of Patient With

Chest Drainage System

By:

Mr. M. Shivanandha Reddy

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

Chest Tube

Indications:

• Pneumothorax• Hemothorax• Pleural Effusion

Pneumothorax

Air between the pleurae is a Pneumothorax• Occurs when there is an

opening on the surface of the lung or in the chest wall — or both

• The opening allows air to enter the pleural space between the pleurae

Hemothorax

Blood in the pleural space is a Hemothorax

Pleural Effusion

•Pleural Effusion–Transudate –Exudate –Empyema

Purpose Of Chest Tube Placement:

1. Remove fluid & air as promptly as possible2. Prevent drained air & fluid from returning to

the pleural space3. Restore negative pressure in the pleural

space to re-expand the lung

1. Remove Fluid & Air As Promptly As Possible

• Correctly positioned chest tube removes the fluid and air that is accumulated because of hemothorax or pneumothorax or pleural effusion

Prevent Drained Air & Fluid From Returning To The Pleural Space

Chest tube is attached to a drainage device – Allows air and fluid to leave the chest– Contains a one-way valve to prevent air & fluid

returning to the chest– Designed so that the device is below the level of

the chest tube for gravity drainage

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

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

Types Of Chest Drainage Systems

• The most commonly used drainage systems are:

1. One bottle / single bottle system2. Two bottle system3. Three bottle system

One Bottle / Single Bottle System

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

Two Bottle System

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.

Three Bottle System

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

Pleuro Vac

Pleuro Vac

Precautions To Be Taken For A Patient With Chest Tube:

• Keep a chest tube system closed and below the chest

• The tube should be secured to the chest wall.• Watch for slow, steady bubbling in the suction-

control chamber and keep it filled with sterile water at the prescribed level.

……. Precautions

• Make sure that the water-seal chamber is filled to the manufacturer specified level and watch for fluctuation (tidaling) of the fluid level to ensure that the chest tube and system are working.

• Make sure connections are tight and taped• Report any unexpected cloudy or bloody

drainage.

……. Precautions• A constant or intermittent bubbling in the

water-seal chamber indicates a leak in the drainage system, and the health care provider must be notified immediately.

• Mark the level on the outside of the collection chambers every shift.

• Do not let the tubing kink or loop, and ideally it should lie horizontally across the bed or chair before dropping vertically into the drainage device.

……. Precautions

• Encourage your patient to cough, deep breath, and use the incentive spirometer.

• Make sure that he or she is frequently repositioned and ambulated if not contraindicated.

• Routinely assess respiratory rate, breath sounds, SpO2 levels, and the insertion site for subcutaneous emphysema

……. Precautions• Clamping a chest tube is contraindicated when

ambulating or transporting a patient. Clamping can result in a Tension Pneumothorax

• Handle the chest drainage unit carefully and maintain the drainage device below the patient’s chest.

If The Tubing Disconnects From The Drainage……

• Seal off insertion site – dry, sterile dressing or, petroleum gauze dressing

• instruct the patient to exhale as much as possible and to cough. This maneuver rids the pleural space off as much air as possible.

• Temporarily re-establish a water seal by immersing the open end of the chest tube into a container of sterile water

Termination of Chest Tube• Explain procedure to patient • Equipment– Suture removal kit, gloves, Vaseline gauze,– 4x4s, tape, towels

• Tube should be pulled at the end of full inspiration.

• Some physicians prefer coughing or holding breath to increase intrathoracic pressure

• Occlusive dressing