Placement Position o Seated on edge of bed with arms supported on bedside table o Supine with midaxillary area exposed o Sutured in with dressing on top Removing air o Air rises o Placed higher in chest wall directed anteriorly and superiorly Removing fluid o Placed lower o Directed posteriorly and inferiorly (towards back and down) Flutter or Heimlich valve Has a one way flutter valve Air can escape but not enter o Air exits during expiration o Valve closes when breathing in. Emergency transport, small pneumothorax, and ambulation Can go home with this Drainage Systems (2) Flutter valve connected to drainage bag o For chronic pleural effusions and simple pneumothorax Chest Drainage Units 3 compartments o Collection chamber Receives fluid and air Fluid collects in collection chamber Air travels to the water seal chamber o Water Seal Chamber 2 cm water = one way valve air moves from collection chamber water seal chamber Air bubbles up through the water Initial brisk bubbling of air is normal after placement Intermittent bubbling normal, expected when breathing out, coughing or sneezing increases = leak in system or from patient
Tidaling Normal fluctuation of water during inspiration and expiration Stops when air leak seals and lung has reexpanded No tidaling when system attached to suction
o Suction Control Chamber applies suction to CDU. 2 types:
Water Suction 20 cm of water top exposed to atmosphere has bubbling when air enters from atmosphere When excess suction is applied draws in air through the top of the chamber and air bubbles up through the water. (suction breaker effect) To initiate suction: o Vacuum source turned up until gentle bubbling is present o Excessive bubbling doesnt increase suction, just makes water evaporate faster Dry Suction No water Visual alert indicates that suction is working Turn dial on system to increase pressures Nursing of CDUs Never clamp o Will cause tension pneumo o Only to change system, check for leaks o Clamped to assess how removal will be tolerated Disconnection o Reestablish water seal system immediately o New system asap o 2 cm sterile water until new system is connected Monitor position and lung expansion with x-ray Risk of infection at insertion site sterile dressing changes! Removal o By doctor o Lungs have reexpanded o Fluid isnt draining anymore o Suction discontinued, drained by gravity for 24 hours o Premedicate patient with pain meds
o Sterile airtight petroleum jelly dressing cover
immediately o Tell patient to hold breath or bear down when removing (valsalva) o Chest x-ray afterwards, watch for respiratory distress Look in medsurg book on p.572