Chest drainage

Are used in also in treatment of pneumothorax and

trauma resulting in pneumothorax, often used after thoracic surgery When chest is opened, there is loss of negative pressure, resulting in the collapse of the lung Chest tubes may be inserted to drain fluid or air from any of the three compartments of the thorax.

 Air and fluid collect in the pleural space, restricting

lung expansion and gas exchange Placement of the tube in the pleural space restores the negative intrathoracic pressure needed for lung re-expansion ff. surgery or trauma.

Types of chest drainage systems

1. Traditional water seal (also referred to as

wet suction)- has 3 chambers: a collection chamber, water seal chamber, wet suction chamber Requires sterile water be instilled in water seal and suction chambers Has negative and positive pressure release valves

 Intermittent bubbling indicates that the system is

functioning properly Additional suction can be added by connecting system to a suction source

2. Dry suction water seal ( dry suction)- has 3 chambers: a collection chamber, water seal chamber and dry suction control chamber Requires that sterile water be instilled 2 cm, level No need to fill suction chamber with fluid Suction pressure is set with regulator Has (+), (-) pressure release valves Has indicator to signify adequate pressure Quieter than traditional water seal systems

3. Dry suction (one-way valve system)- has one way mechanical value that allows air to leave the chest and prevents air from moving back into chest No need to fill suction chamber with water; can be set up quickly in an emergency Works even if knocked over, making it ideal for patients who are ambulatory

PLANNING AND IMPLEMENTING CARE FOR THE CLIENT AND CHEST DRAINAGE SYSTEM

1. Nursing Care Should be determined: promote safety

 Secure all connections from being pulled apart Pins should not be used to secure tubings

Bottles must be kept below the level of the chest

Place bottles at distances of 18 inches below the

chest level

 Electrical beds should be locked in place Instruct environmental services, or any personnel

or family members not to lower the bed for cleaning or other reasons Bottles must be taped to the floor

 Use aseptic technique when changing bottles and

chest tubes Chest tubes should never be clamped Procedure should always be done at bedside

2. Maintaining patency of the drainage tube

Check for patency of the tube

The tubing should be periodically milked or stripped

on a downward motion away from the clients chest.

3. Making Assessment
Observe the amount, color and character of drainage

Assess for increments of fluid drainage and note

If over 500 ml of bloody drainage is lost within 24

hrs. it is considered excessive. If more than 100 ml is lost within 1 hr. notify physician

 The nurse must observe for fluctuations in the water

seal bottle. Fluctuations usually occur for at least 36 to 72 hours after surgery During early chest drainage, bubbling may appear in the water-seal bottle

 Persistent bubbling in the bottle indicates the

presence of small leaks from the surface of the lungs. Bubbling occurring in the bottle should be intermittent Bubbling in the suction control bottle should be continuous

4. Preventing complications
Client should be placed in semi-fowlers position,

turned every 2 hours or, made to lie on the affected side Encourage the client to cough, breath deeply, and engage in other activities

5. Removing tubes
Instruct client to take a deep breath and to exhale as

the tubing is quickly withdrawn Make frequent observations for signs of air leakage and for symptoms of respiratory disease The dressing must be reinforced for the first 48 hours

6. Planning for emergencies

Measure should be taken when the test tube is

accidentally becomes dislodged to prevent air from entering the chest. Notify physician Immediately prepare for reinsertion like the solution for cleansing the area

 When the wall vacuum is turned off, the

drainage system must be open to the atmosphere so that intrapleural air can escape from the system. This can be done by detaching the tubing from the suction port to provide a vent.

 If the chest tube and drainage system is

detached , air can enter the pleural space, producing a pneumothorax. To prevent pneumothorax if the chest tube is inadvertently disconnected from the drainage system, a temporary water seal can be established by immersing the chest tubes open end in a bottle of sterile water.