Chest Drainage Performance Checklists - Atrium Medical Corporation

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Chest Drainage Performance

Checklists

Author:

Patricia Carroll, RN, BC, CEN, RRT, MS Owner, Educational Medical Consultants

Faculty, School of Health Sciences, Excelsior College

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This manual is designed to assist you as you plan to assess competence of nurses caring for

patients requiring chest drainage. No guarantees are made that the information contained

within is the only information required for accreditation purposes, or that this information will

meet all accreditation requirements. You may copy checklists from this manual only for the

purposes of using them in practice in your institution with Atrium products. No representation

is made for the applicability of the checklists for other manufacturers' chest drains. This

manual is © 2012 Atrium Medical Corporation, a MAQUET GETINGE GROUP company. All

rights reserved.

Atrium Medical Corporation 5 Wentworth Drive Hudson, NH 03051 Phone 800-528-7486 Fax 603-880-6718 www.atriummed.com

Atrium Medical Corporation Rendementsweg 20 B 3641 SL Mijdrecht, The Netherlands Phone +31-297-230-420 Fax +31-297-282-653

Atrium Australia-Pacific Rim Pty. Ltd. Level 6, 579 Harris Street 3 Brady Street Ultimo NSW 2007 Australia Phone +61-2 8272 3100 Fax +61-2-8272 3199

http://www.atriummed.com/

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Chest Drainage Performance Checklists

Our goal with these checklists is to help you develop methods for assessing

the competence of your nursing staff to care for patients with chest tubes who

require chest drainage.

Ever since Joint Commission developed the competency standard, nurse

managers, educators, and clinical specialists have felt the burden of assessing

staff competence.

While checklists aren't the best or only way to assess competent practice, we have written

psychomotor checklists for each Atrium drain as well as for implementing autotransfusion to

provide customers with a variety of options. Feel free to photocopy these checklists for clinical

use with Atrium drains.

Each checklist features reference numbers that correspond to comments providing additional

information, tips, or recommendations for individual checklist items. In the Table of Contents,

these are called evaluator notes. We have designed the manual so that you can photocopy the

checklist on one side of the page and the evaluator notes on the back. Some drains have

additional information pages that can stay in the manual. Note, that we use the term “vacuum” to

refer to a pressure below atmospheric pressure. The term “suction” is used to describe clinical

application of that negative pressure. Video demonstration of drains’ proper set-up is available on

DVD or online at www.atriummed.com/drainhelp.

We appreciate your feedback. Please don't hesitate to let us know how we can improve this tool

or develop other tools about chest drainage to make your job easier. You can call Atrium Medical

Corporation at (800) 528-7486 or visit us on the web at www.atriummed.com/drainhelp.

For non product-specific information and professional education materials, visit www.AtriumU.com, the website for Atrium University, funded by an unrestricted educational grant from Atrium Medical Corporation.

http://www.atriummed.com/

http://www.atriumu.com/

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Table of Contents

Psychomotor Checklists Atrium Ocean™ Water Seal Chest Drains .......................................................................................... 6-8 Checklist 6 Notes for evaluator 7 Additional information 8 Atrium Oasis™ Dry Suction, Water Seal Chest Drains ................................................................. 9-11 Checklist 9 Notes for evaluator 10 Additional information 11 Atrium Express™ Dry Seal Chest Drains ...................................................................................... 12-14 Checklist 12 Notes for evaluator 13 Additional information 14 Atrium Chest Drain Autotransfusion: Continuous ................................................................ 15-16 Checklist 15 Notes for evaluator 16 Atrium Chest Drain Autotransfusion: Self-Filling Bag Collection………… . ………………….17-18 Checklist 17 Notes for evaluator 18 Atrium Chest Drain Autotransfusion: Blood Bag Infusion……… …………… . ……………….19-20 Checklist 19 Notes for evaluator 20 Atrium Chest Drain Autotransfusion: In-Line Blood Bag Collection………… . ……………….21-22 Checklist 21 Notes for evaluator 22 Atrium Express™ Mini 500 Dry Seal Mobile Chest Drains ......................................................... 23-24 Checklist 23 Notes for evaluator 24 Atrium Pneumostat™ Chest Drain Valve ...................................................................................... 25-26 Checklist 25 Notes for evaluator 26

Psychomotor

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Checklists In keeping with the philosophy that competence can be assessed in many ways, here are some tips

for using the checklists that follow.

Rather than simply checking "Yes" or "No" on the checklist, as has

been traditionally done in "competency fairs" or clinical laboratory

"check-offs," you can instead use a code as to how competence was

evaluated.

For example, under the "Yes" column of the checklist, you might want

to consider using the following codes rather than a check mark:

T The item was met through testing

O The item was observed in actual clinical practice

C The item was evaluated by reviewing patient charts / documentation

Q The item was evaluated through CQI / TQM or risk management review

You can add other codes based on your institutional guidelines for evaluating nursing

competence.

The checklists are designed to be photocopied with the checklist on the front and the explanations of

each item on the back. On the form, NA means not applicable, NI means needs improvement. If an

item is marked "needs improvement," a plan for improving competence should be documented.

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Psychomotor Checklist: Atrium Ocean Water Seal Chest Drains

Psychomotor Skills

Collect and prepare needed equipment and supplies:

1. Atrium Ocean Water Seal Chest Drain

2. Tubing to connect drain to vacuum source (if ordered)

3. Sterile fluid (500mL)

Yes No NA NI

Open package and open sterile wrap1

Swing out floor stand and set drain upright on floor stand2

If present, slide the blue tube clamp next to the in-line connector3

Fill water seal chamber to 2cm fill line by using funnel; remove funnel after use and discard4

Fill suction chamber to desired suction level after removing gray vent plug5

Replace gray vent plug over suction control chamber opening after filling6

Connect chest drain to patient, maintaining sterility of tube connector7

Connect chest drain to vacuum source, using hospital connecting tubing8

Check that drain suction tubing stopcock is in open position9

Turn vacuum source on10 AND

Increase source vacuum for constant, gentle bubbling in suction control chamber11

If source vacuum cannot be adjusted, adjust bubbling with suction tubing stopcock (if present)12

Demonstrate three ways to maintain drain below patient’s chest level13

Observe water seal chamber for bubbling or tidalling14

Assess water level in water seal chamber15

Activate manual high negativity vent and state when activation is indicated16

Adjust water level in water seal & suction control with 20 gauge needle

& syringe17

Assess fluid level in suction control chamber and describe or

demonstrate how to add fluid if needed18

Demonstrate drain set-up for gravity drainage19

Evaluator Date

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Psychomotor Checklist: Atrium Ocean Water Seal Chest Drains

*indicates additional information on following page

1 Double sequential wrap allows drain to be handed into sterile field for setup in the OR; all contents are sterile. (If sterile

fluid path packaging is used, drain is not entered into sterile field. Instead, sterile patient tube pack is passed into the

sterile field. The inside of drain is sterile; outside is not.) In other clinical settings, remove the connector cap and, using

sterile technique, attach the drain’s connecting tubing to the chest tube.*

2 Floor stand maintains unit stability during setup.

3 Patient clamp should remain open at all times during use so tube is not inadvertently closed off. Positioning it close to the drain keeps it visible.

4 Fill water seal chamber to the indicated 2cm level. Pull attached funnel forward and down creating a loop where funnel

enters tubing. Fill funnel to the top with sterile fluid. Lift funnel straight up, straighten tubing and fluid will flow into water

seal chamber. Funnel automatically measures correct amount of fluid, 45mL*.

5 Typically filled to -20cmH2O. Requires approximately 330mL*

6 Vent plug helps dampen sound of water bubbling.

7 Tubing is sterile when package opened. Tubing can be maintained in sterile field if drain is set up in the OR.

Otherwise, the cap can be removed from patient connector, and tubing can be passed to sterile field during bedside chest

tube insertion (or changing chest drains), since connector remains sterile. Sterile connector slides into sterile chest tube.

8 Vacuum source can be wall vacuum regulator or electric vacuum pump; connecting tubing comes from hospital stock.

9 Stopcock should remain open so there is no obstruction to air flow; however, the patient will not be at risk if the

stopcock is inadvertently closed because of built-in safety features (Positive Pressure Release Valve). Suction will not be

applied if stopcock is closed. *

10,11 As soon as bubbles appear, excess negativity is vented into the atmosphere. Vigorous bubbling is not required for

standard use and will cause water to evaporate more quickly.

12 If vacuum source cannot be adjusted, the stopcock can be gradually closed to limit rate of flow removing air from the

chest drain and regulate bubbling if required. *

13 Gravity will assist drainage into chest drain. The floor stand, hangers, and carry handle will keep it in the proper

position.

14 Bubbling indicates air leak is present; tidaling reflects normal pressure changes in the chest with breathing. Nurses should describe air leak monitor 1 (low) to 5 (high) according to hospital procedure for assessment and documentation.

15 Baseline water level is the 2cm level. If there is a condition of increased negative pressure in the chest, the water

level in the small arm of the water seal will rise.

16 The manual high negativity vent should be used to manually lower the height of water in the water seal chamber. It is used only when drain is operating with source (typically wall) vacuum. *

17 Fluid can be added and removed from the water seal chamber & suction control chamber, using a needle (20 gauge

or smaller) and syringe through the gray injection ports on the back of the drain.

18 Pinch off connecting tubing momentarily to assess fluid level; add fluid through the top of the drain after removing the

gray vent plug and momentarily stopping source vacuum. Re-establish suction and check operation after fluid is added.

19 Disconnect the connecting tubing from the drain. Ensure the stopcock on the suction tubing is in the fully open

position, and that the blue patient clamp next to the in-line connector on the patient tubing is also open when preparing

the patient for gravity drainage, ambulation, or transport.

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Additional Information Atrium Ocean Water Seal Chest Drains

Item 1 Once sterile wrap is opened, the drain is face down in the cardboard tray. Tubing is tucked into

a sterile pocket on the back of the drain.

Items 4,5 The Ocean Water Seal Chest Drain requires 375mL of sterile fluid to establish the water seal

and suction control chambers. Sterile saline is recommended if autotransfusion will be

implemented.

Item 9 The stopcock in the drain suction tubing must be open in order to fill suction control chamber

with water. When a regulated vacuum source is used, there is no need to adjust the stopcock

position for operation. If the stopcock is closed, the patient will not be at risk, but bubbling will

not occur in the suction control chamber and the patient will not have suction applied to the

chest.

Item 12 In some patient care settings, regulated vacuum is not available. In this case, attach the

connecting tubing to the drain first and close the stopcock before turning the vacuum source

on. Then, slowly open the stopcock until there is gentle bubbling in the suction control

chamber.

Item 16 The manual high negativity vent is used to vent negative pressure from the system and return the level of water in the water seal chamber to baseline. (If the water goes all the way to the top of the water seal, the drain will automatically vent and the water will return to baseline — in this case, there is no need to use the manual high negativity vent.)

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Psychomotor Checklist: Atrium Oasis Dry Suction Water Seal

Chest Drains

Psychomotor Skills

Prepare and collect needed equipment and supplies:

1. Atrium Oasis Dry Suction Chest Drain


3. Note: Sterile water is provided with drain

Yes No NA NI


Swing out floor stand and set drain upright on floor stand2

If present, slide the blue tube clamp next to the in-line connector 3

Remove ampoule of sterile water from the back of the drain, twist off

the top, and add water to the water seal chamber through the blue

suction port (located on the top, left-side of the drain, in front of the

carry handle).4

Fill water seal chamber to 2cm fill line; remove, and discard ampoule5

Connect chest drain to patient, maintaining sterility of tube connector6

Connect chest drain to vacuum source by attaching hospital connecting

tubing to the blue suction port on top of the drain7

Adjust suction regulator on drain to desired level by turning dial located

on the left side of the chest drain8

Turn vacuum source on; increase source level to -80mmHg or higher9

Check suction monitor bellows; state indicator of proper bellows

expansion10

If bellows is not at or past mark, increase source vacuum pressure*11

Demonstrate lowering patient suction level: Turn down suction setting

on drain to lower level12 AND

Depress manual high negativity vent (both must be done)13

Demonstrate three ways to maintain drain below patient’s chest level14

Observe water seal chamber for bubbling or tidaling15

Assess water level in water seal chamber16

Demonstrate adjusting water level in water seal with needle & syringe17

Demonstrate drain set-up for gravity drainage18

* For suction pressures of -20cmH2O or greater (more negative)

Evaluator Date

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Psychomotor Checklist: Atrium Oasis Dry Suction, Water Seal

Chest Drains

*indicates additional information on the following page

1 Double sequential wrap allows drain to be handed into sterile field for setup in the OR; all contents are sterile.

(If sterile fluid path packaging is used, drain is not entered into sterile field. Instead, sterile patient tube pack is

passed into the sterile field. The inside of drain is sterile; outside is not.) In other clinical settings, remove the

connector cap and, using sterile technique, attach the patient connector to the chest tube.*

2 Floor stand maintains unit stability during setup.

3 Patient clamp should remain open at all times during use so tube is not inadvertently closed off. Positioning it close to the drain keeps it visible.

5 Fill water seal chamber to the 2cm fill line using the prepackaged sterile water provided with the drain.

Prepackaged water eliminates the need for hospital stock sterile fluid for irrigation during drain setup.*

6 Tubing is sterile when package is opened. Tubing can be maintained in sterile field if drain is set up in the

OR. Otherwise, the cap can be removed from patient connector, and tubing can be passed to sterile field

during bedside chest tube insertion (or changing chest drains), since connector remains sterile. Sterile

connector slides into sterile chest tube.

7 Vacuum source can be wall vacuum or electric vacuum pump; it must provide a minimum vacuum pressure of -80mmHg at 20 LPM for drain operation at suction pressures of -20cmH2O or higher (more negative).

8 Suction level is easily changed by adjusting the suction dial on the side of the chest drain. The dry suction

chest drain comes preset at -20cmH2O and is adjustable from -10cmH2O to -40cmH2O. Dial down to lower

the suction level and up to increase the suction pressure setting.

9 Source vacuum must be set at -80mmHg or higher (more negative pressure).

10,11 For suction pressures of -20cmH2O or greater, the bellows in the suction monitor window must expand to

the mark or beyond. If the bellows does not expand to the delta mark, the source vacuum must be

increased until the bellows reaches the proper point. If the desired suction setting is less than -20cmH2O (for

example -10cmH2O), any visible expansion of the bellows into the window confirms suction operation.

12,13 When suction levels are decreased on a dry suction chest drain, the manual high negativity vent can be

depressed immediately after the adjustment is made to vent the excess negativity remaining in the system.. If

this is not done, the patient and system will be subjected to the higher negative pressure than that indicated by

the suction regulator until pressure equilibrates . (The vent is used only when the patient is connected to

source vacuum.) *

14 Gravity will assist drainage into the chest drain. The floor stand, the hangers, and the carry handle (when

used during ambulation) all maintain the drain in the ideal position for drainage.

15 Bubbling in the water seal chamber indicates there is an air leak present. Nurses should be able to describe

activity observed in the air leak monitor, ranging from 1 (low) to 5 (high) according to hospital procedure for

assessment and documentation. Tidalling reflects normal pressure changes in the chest with breathing.

16 The manual high negativity vent should be used to manually lower the height of the water in the water seal.

It is used only when the drain is operating with source vacuum. *

17 Sterile fluid can be added or removed from the water seal chamber, with a syringe by inserting an attached needle (20 gauge or smaller) into the injection port on the back of the drain.

18 When removing suction and preparing the patient for gravity drainage, ambulation or transport, it is critical to

keep the patient clamp on the patient side of the drain fully open (if present).

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Additional Information Atrium Oasis Dry Suction, Water Seal

Chest Drain

Item 1 Once sterile wrap is opened, the drain is face down in the cardboard tray. Tubing is tucked into a

sterile pocket on the back of the drain. A sterile water ampoule is provided for establishing the

water seal.

Items 12, 13 If the nurse forgets to depress the high negativity vent when adjusting drain suction to a lower

level, the water level in the water seal will rise to reflect this higher negativity and remind the

nurse to depress the manual high negativity vent. The manual vent is only to be used when the

patient is connected to source vacuum.

Item 16 The manual high negativity vent should be used to vent negative pressure from the system and

return the water level to baseline. (If the water goes all the way to the top of the water seal, the

drain will automatically vent and the water will return to baseline — in this case, there is no need

to use the manual high negativity vent.)

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Psychomotor Checklist: Atrium Express Dry Seal Chest Drains

Psychomotor Skills


1. Atrium Express Dry Seal Chest Drain (with pre-packaged water syringe)


Yes No NA NI


Swing out floor stand or hang drain from bed frame, using hangers2

Slide the blue tube clamp next to the in-line connector3

Connect chest drain to patient, maintaining sterility of tube connector 4

Connect drain to vacuum source by attaching connecting tubing to the

suction port on the top of the drain5

Adjust suction regulator on drain to the desired level by turning the dial located behind the face of the regulator up to increase imposed suction and down to decrease imposed suction

6

Turn vacuum source on; increase level to -80mmHg or higher 7

Check suction monitor bellows, verify proper bellows expansion8

If bellows is not at or past the mark, increase source vacuum*9

Using prefilled syringe provided with drain, fill air leak monitor through the needless injection port on the back of the drain; discard syringe according to hospital policy

10

Demonstrate lowering suction level: Turn down suction set on drain11

AND

Depress manual high negativity vent (both must be done) 12

Describe how to determine if negative pressure is detected inside the

drain13

Describe air leak monitoring14

Demonstrate drain set-up for gravity drainage (transport/ambulation) 15

* For suction pressures of -20cmH2O or greater

Evaluator Date

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Psychomotor Checklist: Atrium Express Dry Seal Chest Drains

*Indicates additional information on following page

1 Double sequential wrap allows drain to be handed into sterile field for setup in the OR; all contents are

sterile. (If sterile fluid path packaging is used, drain is not entered into sterile field. Instead, sterile patient

tube pack is passed into the sterile field. The inside of drain is sterile; outside is not.) In other clinical

settings, remove the connector cap and, using sterile technique, attach the patient connector to the chest

tube.*

2 Position the chest drain below the chest to facilitate gravity drainage.

3 Blue slide clamp should remain open at all times during use so patient tube is not inadvertently closed off.

Positioning it close to the drain keeps it visible.

4 Tubing is sterile when package is opened. Tubing can be maintained in sterile field if drain is set up in the

OR. Otherwise, the cap can be removed from patient connector, and tubing can be passed to sterile field

during bedside chest tube insertion (or changing chest drains), since connector remains sterile. Sterile

connector slides into sterile chest tube.

5 Vacuum source can be wall vacuum or electric vacuum pump; it must provide a minimum vacuum pressure of -80mmHg at 20 LPM for drain operation at suction pressures of -20cmH2O or higher (more negative).

6 Suction level is easily changed by adjusting the suction dial on the side of the chest drain. Dial down to lower

the suction level and dial up to increase the suction (preset at -20cmH2O).

7 Source vacuum must be set at -80mmHg or higher (more negative).

8 For suction pressures of -20cmH2O or greater, the bellows in the suction monitor window must expand to the

mark or beyond. If the bellows does not expand to the delta mark, the source vacuum must be increased

until the bellows reaches the proper point. If the desired suction setting is less than -20cmH2O (for example

-10cmH2O), any visible expansion of the bellows into the window confirms suction operation.

10This step is for monitoring purposes and is not required for safe operation of the drain. The air leak

monitor can be filled with 30mL sterile fluid from the included syringe with a Luer fitting connected to the

needless port in the back of the drain.*

11,12 When suction levels are decreased on a dry suction chest drain, the manual high negativity vent can be

depressed immediately after the adjustment is made in order to vent the excess negativity remaining in the

system If this is not done, the patient and system will be subjected to the higher negative pressure than that

indicated by the suction regulator until pressure equilibrates. . (The vent is used only when the patient is

connected to source vacuum.) 13 A check mark in the vacuum indicator window, labeled B, indicates there is negative pressure detected in

the drain (which is consistent with normal pleural pressure).*

14 The air leak monitor, labeled C on the drain, should be observed for bubbling (if filled). *

15 When discontinuing suction for gravity drainage or preparing the patient for ambulation or transport, it is

critical to keep the patient clamp on the patient side of the drain open (if present).

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Additional Information Atrium Express Dry Seal Chest Drains

Item 1 Once sterile wrap is opened, the drain is face down in the cardboard tray. Tubing is tucked

into a sterile pocket on the back of the drain. Items 4,5,6 The drain can be used without additional set up; the suction level is pre-set to-20cmH

2O,

simply connect to vacuum source. Drain may also be used without suction. Item 10 The Express Dry Seal Chest Drain has a dry seal valve, a mechanical one-way valve located

inside the drain that performs the same function as the water seal chamber in a “wet seal” drain. The chamber on the Express Dry Seal Chest Drain looks like a water seal chamber, but it is actually an air leak monitor. The patient is completely protected without adding any water to the drain during set-up. Water is only needed to establish the air leak monitor. If water is added, it provides a redundant one-way valve protection, just as in a traditional water seal drain. Keeping the drain face down will facilitate injecting fluid into the air leak monitor.

Item 13 A check mark in the vacuum indicator window, labeled B, indicates negative pressure is detected in the drain (which could be normal pleural pressure). When pleural pressure is positive, such as during a cough, the check mark should disappear.

Item 14 Do not rely on water level movement in the air leak monitor for patient assessment; because of the dry seal valve, this chamber is not a window to the pleural space, as is the case with a traditional water seal chamber. Observe the air leak monitor for bubbling only. The drain is safe to use without water in this part of the drain since the patient is fully protected by the dry-seal valve.

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Psychomotor Checklist: Atrium Chest Drain Autotransfusion -

Continuous

Continuous ATS with Blood Compatible Infusion Pump

Note: Must maintain proper standard precautions during autotransfusion procedures.

Based on hospital policy or physician order, anticoagulant may be added to collection chamber.

Psychomotor Skills


1. Atrium ATS Chest Drain

2. Microemboli blood filter (40

3. Non-vented, blood compatible IV pump tubing set

Yes No NA NI

Assure clamp on ATS access tubing on drain is closed and drape access tubing around the patient line or drain hanger

1

Open cap on end of access tubing and attach blood filter using aseptic

technique2

Attach IV tubing to blood filter

Attach three-way stopcock and syringe to distal end of tubing in order to

pull blood out of drain to prime filter3

Connect 60 mL syringe to stopcock side port with Luer connection

Open clamp on access tubing

*While keeping filter and IV tubing drip chamber “upside down” aspirate

blood using the syringe to prime the filter and the drip chamber until the

chamber is one-quarter filled4,5

Turn the tubing “right side up” and continue to aspirate, filling the

tubing with blood and purging all air6

Dispose of syringe following proper hospital protocol for medical waste

Insert tubing into IV pump, according to pump manufacturer

instructions, and connect to patient site for infusion as per hospital

policy and procedure

Trace the IV tubing from (1) the filter connection to the access line on

chest drain (2) to pump and then (3) to patient connection; ensure

connections are tight and system is free of air

Set infusion pump rate and volume to be infused based on rate of

patient drainage and begin infusion

Record drainage volume according to hospital procedure (see note)

*Alternatively, self-priming IV blood pump can be used; follow pump manufacturer recommendations for self-priming and required IV tubing

Evaluator Date

4. Infusion pump compatible with blood infusion

5. 3-way stopcock

6. 60cc syringe

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Psychomotor Checklist: Atrium Chest Drain Autotransfusion - Continuous

1. ATS access tubing is clear and connected to the bottom of the collection chamber in the back of the

drain. The clamp is white.

2. Cap remains tethered to access tube; for ease of use, drape the access tube around the patient tube or

drain hanger before attaching the filter.

3. Stopcock is placed on the patient end of the IV tubing.

4. “Upside down” means the filter is inferior to the drip chamber for priming.

5. While filling drip chamber when “upside down,” it should be filled one-quarter (25%) of the distance from

the bottom to the top of the chamber. Note that the drip chamber diameter is graduated; initially the end

with the larger diameter is filled with blood. When the chamber is inverted for infusion, the same volume

of blood will now fill one-half (50%) of the distance from the bottom to the top of the chamber because

the end with the smaller diameter is now filled.

6. “Right side up” means the filter is superior to the drip chamber for infusion.

Note: Based on hospital policy and procedure, patient drainage, time, and infusion rate and volume are monitored. Include the hospital-specific worksheet or documentation form as the final step of the psychomotor assessment process.

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Psychomotor Checklist: Atrium Chest Drain Autotransfusion –

Self-Filling Blood Bag


Based on hospital policy or physician order, anticoagulant may be added to collection chamber.

Proper identification and labeling of ATS bag according to hospital policy are essential.

Psychomotor Skills


1. Atrium ATS Chest Drain

2. Atrium Self-Filling Blood Bag

3. Microemboli blood filter (40

4. Non-vented, blood compatible IV administration tubing set

Yes No NA NI

Check that white clamps (1) on ATS access tubing on drain1 and (2) on ATS

bag are closed

Remove cap covering spike port at the end of chest drain ATS access line2

Insert the ATS bag spike into the chest drain ATS access line with a firm, twisting motion

3

Position bag below the base of the collection chamber to facilitate gravity

drainage

Open clamps: first on ATS access line, then on the ATS bag

Gently bend the bag where indicated to activate blood transfer4

Monitor blood transfer from chest drain to bag

As necessary, gently squeeze bag as needed to push air back into drain, maximizing fluid capacity of bag

When transfer is complete, close clamps on access line and bag5

Remove ATS spike from access line port and replace in spike holder on bag; re-cap access line port

Label bag with patient identification information & expiration time according to hospital policy & procedure

Evaluator Date

For blood infusion checklist, see page 21

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Psychomotor Checklist: Atrium Chest Drain Autotransfusion – Self-Filling

Blood Bag

1. ATS access tubing is clear and connected to the bottom of the collection chamber in the back of the

drain. The tubing clamp is white.

2. Cap remains tethered to access tube.

3. For packaging, the spike is placed in the filtered air vent assembly; simply pull on the flange at the base

of the spike to free it, then place the spike in the ATS access tubing.

4. Do not activate bag until connected to chest drain.

5. Assure ATS access line clamp remains closed when not in use.

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Psychomotor Checklist: Atrium Chest Drain Autotransfusion — Infusion From Blood Bag Note: A new microemboli blood filter must be used for each ATS bag.

Prime IV blood administration set and microemboli blood filter with sterile saline or blood (according to hospital policy & procedure)

Invert ATS bag with spike port up; use aseptic technique to remove cap

Insert blood filter spike into bag; return bag to upright position and hang on IV pole

Open air vent on top of bag, then open IV tubing clamp to complete priming1

Fill tubing to remove all air. Attach to patient and begin infusion

Monitor transfusion and document according to hospital policy

Evaluator Date

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Psychomotor Checklist: Atrium Chest Drain Autotransfusion – Infusion

From Blood Bag

1. For pressure infuser use, leave air vent on ATS bag closed. No more than 150mmHg pressure should be

applied to ATS bag during reinfusion.

Note: Based on hospital policy and procedure, patient drainage, time, and infusion rate and volume are monitored. Include the hospital-specific worksheet or documentation form as the final step of the psychomotor assessment.

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Psychomotor Checklist: Atrium Chest Drain Autotransfusion –

In-Line Blood Bag


Based on hospital policy or physician order, anticoagulant may be ordered. Proper

identification and labeling of ATS bag according to hospital policy are essential.

Packaging is double-wrapped so bag can be entered into sterile field if necessary.

Psychomotor Skills


1. Atrium Chest Drain (with in-line connectors)

2. Atrium In-Line Blood Bag

3. Microemboli blood filter

4. Blood compatible IV administration tubing set

Yes No NA NI

Hang the in-line chest drain ATS blood bag on the front of the chest drain using the bag’s metal hanger

1

Close both white clamps on ATS bag2

Slide the blue clamp on the patient tubing of the chest drain down to the in-line connector at the top of the drain; close the clamp when ready to attach the bag

3

Remove the caps from the two tubes on the ATS bag

Open the in-line connector by pressing the connector lock and pulling the two sides of the connector apart

Place the patient tube into the tube on the right side of the bag4

Place the tube on the left side of the bag into the drain tubing5

Open the clamps on the ATS bag6

Open the clamp on the patient tube; all clamps must remain fully open during use

7

Position tubing to eliminate dependent loops that could hamper drainage

Record blood volume in ATS bag according to hospital policy & procedure8

To disconnect ATS bag from chest drain system, close both clamps on the ATS bag and the clamp on the patient tubing

Disconnect the tube on the left side of the ATS bag from the drain, then disconnect the tube on the right side of the ATS bag from the patient tube

Immediately reconnect the patient tube to the chest drain tubing using the in-line connector and open the patient clamp to re-establish drainage

9

Connect the tubes on the top of the ATS bag to form a closed system for reinfusion

For blood infusion checklist, see page XX

Evaluator Date

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Psychomotor Checklist: Atrium Chest Drain Autotransfusion In-Line Blood

Bag

1. The blood bag may also be hung from bed frame / rail.

2. Close clamps before protective caps are removed.

3. Remember that closing this clamp blocks air and fluid evacuation from the chest.

4. Insert the male connector on the patient tube into the female connector on the bag.

5. Insert the male connector on the bag into the female connector on the drain tubing; quickly trace patient tube to bag, away from bag and to drain, ensuring all connections are made and are airtight.

6. The bag clamps are opened first to allow the bag to equilibrate with vacuum level in the system.

7. Seeing initial fluid drainage in the bag confirms set-up is correct and that patient tube clamp has been properly released.

8. Note that the drainage measurements on the left side of the bag are used when there is no vacuum applied; measurements on the right side of the bag apply when the system is subjected to -20cmH2O. All

measurements are approximate.

9. Seeing fluid drainage in collection chamber confirms set-up is correct and that patient tube clamp has been properly released.

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Psychomotor Checklist: Atrium Express Mini 500 Dry Seal Chest

Drains

Psychomotor Skills


1. Atrium Express Mini 500 Dry Seal Chest Drain


Yes No NA NI


Identify components: mobile chest drain, accessory adapter package, and tubing package

2

Using aseptic technique, open both packages3

While maintaining aseptic technique, select the appropriate sized adapter and insert it into the open end of the drain’s patient tube

4

Close blue slide clamp on patient tube5

Using aseptic technique, connect drain patient tube with connector to chest tube or thoracic catheter

6

Remove caps from the patient tube and the corrugated tube on the drain and connect the patient tube to the drain's tube until it clicks

7

Open patient tube clamp8

Connect chest drain to vacuum source by attaching connecting tubing to the suction port on the top of the drain (if ordered)

9

Slowly increase source vacuum to at least -80mmHg10

Identify suction is on11

Describe how to determine if vacuum (negative pressure) is present inside the chest drain system

12

Explain how to determine if the patient has an air leak from the chest tube13

Describe two ways to keep the drain below the level of the chest tube site14

Evaluator Date

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Psychomotor Checklist: Atrium Express Mini 500 Dry Seal Chest

Drain

1 All items inside double sequential blue wrap are separate and sterile.

2 Multiple adapters are provided to facilitate connections to a variety of chest tubes and thoracic catheters.

3 The packages will typically be opened over the sterile field for chest tube insertion and the contents

allowed to drop on the field so that the contents will remain sterile.

4 This is typically done by the clinician inserting the chest tube or thoracic catheter.

5 The patient tube can be handed out of the sterile field at this point. The assisting nurse can close the

slide clamp before connecting to the device, or the clinician can close the slide clamp in the sterile field

and hand the tubing off after connecting it to the patient.

6 This is typically done by the clinician inserting the chest tube or thoracic catheter.

7 Use aseptic technique when uncovering and attaching tubing connectors.

8Tubing clamp must remain open at all times chest drain is in use and needs to be opened before suction

(optional) is applied to the system.

9 Suction tubing is used the same way as it is on a larger, traditional bedside chest drain.

10, 11 The vacuum source must be able to generate -80mmHg with at least 20 LPM (if used); internal suction

regulator is fixed at -20cmH2O.

12 When vacuum is present, a check mark will appear in the window marked C on the drain.

13 To assess for an air leak, fluid must be present in the collection chamber. If there is no drainage, 20mL

sterile fluid may be added with a Luer connector syringe through the needleless access port. (Be sure to

note any fluid added so it is not measured as drainage.) Temporarily tip the drain 90 degrees so that the

numbers indicating drainage volume are at the bottom of the front of the drain. This will allow fluid to fill

window A, through which bubbling can be observed.

14 The drain can be maintained below the chest tube insertion site by using the attached belt straps or the

single hanger by which the drain can be hung from the bed frame.

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Psychomotor Checklist: Atrium Pneumostat Chest Drain Valve

Psychomotor Skills


1. Atrium Pneumostat Chest Drain Valve

2. Sterile scissors, if not already part of sterile chest tube insertion tray

3. 3mL syringe and sterile fluid

Yes No NA NI

Peel open packaging, maintaining sterility1

Using sterile technique, cut off the beveled end of the chest tube or

patient catheter and firmly insert the stepped connector on top of the

Pneumostat tube sized 24-40 Fr2

Alternatively, if the patient catheter is 8-20 Fr, use sterile technique and

attach the short tube containing the small blue stepped connector on the

Pneumostat device; the small stepped connector is then inserted firmly

into the patient tube as above3

Alternatively, if the patient catheter is a thoracentesis catheter, use sterile

technique and attach the short tube containing the Luer connector

to the Pneumostat device; the Luer lock connector is then attached to

the patient tube4

Add 1mL of sterile fluid to the air leak well, if desired, to monitor air leak5

Describe monitoring for air leak6

Maintain Pneumostat below the level of the chest tube insertion site to

facilitate gravity drainage7

Describe drainage monitoring and removal of fluid drainage (if needed)8

Evaluator Date

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Psychomotor Checklist: Atrium Pneumostat Chest Drain Valve

1 The Pneumostat package will typically be opened over the sterile field for chest tube insertion and the

contents allowed to drop on the field so that the contents will remain sterile.

2 Depending on the patient chest tube, the bevel at the end of the catheter may be longer than the stepped

connector, which may result in air leaks. The Pneumostat stepped connector fits chest tubes sizes 24 Fr

to 40 Fr.

3 The nurse should be able to identify the small blue stepped connector component of the Pneumostat

package and its use.

4 The nurse should be able to identify the Luer connector component of the Pneumostat package and its

use. NOTE: This Luer connector is designed to attach to a patient catheter only. Do not attach this Luer

connector to the bottom of the Pneumostat collection chamber.

5 The nurse should be able to identify the air leak well.

6 Bubbling through the fluid in the well indicates an air leak is present.

7 Since the device is so light, it will hang freely, so it can move like a pendulum and always remain gravity

dependent regardless of whether the patient is supine or upright; alternatively, the device can be taped to

the chest.

8 The Pneumostat is designed for patients with air leaks only; the 30mL collection chamber is designed as a

reservoir for physiologic straw-colored pleural fluid. If bloody drainage is present, or drainage is

accumulating at more than approximately 20mL per day, the Express Mini 500 Chest Drain may be more

appropriate. Fluid may be removed for sampling through the Luer port on the bottom of the Pneumostat.

Chest Drainage Performance Checklists - Atrium Medical Corporation

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Transcript of Chest Drainage Performance Checklists - Atrium Medical Corporation