Facebook Instagram Pinterest Youtube. Posted in Med Surg. What is a chest tube? How does a three-chamber system work? The collection chamber simply collects any fluid from the lungs. This can be sanguineous to serous fluid and everything in between.
The water seal chamber uses water as a seal that prevents any air from going back in toward the patient, while allowing both air and fluid to come FROM the patient. The suction control chamber does just that…controls the amount of suction. When is a chest tube used? A chest tube is used in a variety of situations, but mainly falls into a few categories: After any surgery that opens the chest wall. When the surgeon cuts into the chest wall, air enters that space which leads to a loss in negative pressure.
Surgery such as a thoracotomy can also lead to blood residing in the pleural space as well…we want to get that out of there and a chest tube helps us do that! Any introduction of air into the pleural space. This can be due to trauma or pneumothorax. A pneumothorax can occur spontaneously in patients with lung cancer, COPD, cystic fibrosis, HIV associated pneumonia, tuberculosis and pneumonia.
Trauma can also cause a pneumothorax, namely a penetration trauma knife, spear, bullet or a fractured rib. Blood in the pleural space. This is called a hemothorax. Common causes also include trauma, cancer and TB…but can also be a result of thoracic or cardiovascular surgery. Other causes include tears in the vessel wall due to central line insertion or even severe hypertension. Empyema purulent fluid in the pleural space , pleural effusions common in cancers and even lymphatic fluid in the pleural space.
How do I manage a chest tube? This includes: two clamps without teeth , a bottle of sterile water and an occlusive dressing. Perform a full respiratory assessment at appropriate intervals this may depend upon your institution and patient acuity. Ensure the insertion site is clean, dry and intact. Check for crepitus subcutaneous air. Mark the border where the crepitus ends so you can easily ascertain if it worsens or improves. If the crepitus is new, make sure the MD is aware.
Not sure what it feels like? Have the patient repeat this a few times. If you suspect air entered the pleural space before you got to the scene, the patient may be at risk for a tension pneumothorax, which can become life-threatening unless the air is expelled from the pleural space quickly. Notify the practitioner, obtain a chest X-ray, and prepare for possible insertion of a new chest tube.
Or place the end of the tube in a bottle of sterile water, creating a water seal. Instruct a colleague to prepare a new sterile chest-drainage collection device, or retrieve a new sterile connector while you safely return the patient to bed.
Observe the patient for signs and symptoms of respiratory decline. Then reconnect the chest tube to the new drain and unclamp it. Whether chest-tube removal was planned or unplanned, monitor the patient closely for signs and symptoms of respiratory compromise, using such techniques as pulse oximetry Spo2 , end-tidal carbon dioxide ETco2 monitoring, and breath sound auscultation. A repeat chest X-ray if indicated may be done to compare to previous films and evaluate for presence or return of a pneumothorax, an effusion, or other problem.
Other chest-tube complications also can be dangerous. These include extremely high negative pressures within the system caused by aggressive tube stripping, as well as the re-expansion pulmonary edema phenomenon, which results from rapid removal of large amounts of air or fluid. Rarely, inadvertent chest tube misplacement in the liver, spleen, lung, or great vessel can occur on insertion.
See Chest-tube complications. Enhancing your knowledge of chest tubes and gaining the skills needed to manage them improve your confidence in delivering safe patient care. Prevention and management of postoperative air leaks. Ann Cardiothorac Surg. Is routine chest radiograph necessary after chest tube removal? J Pediatr Surg.
Reexpansion pulmonary edema after therapeutic thoracentesis. Clinics Sao Paulo. Comparison of ice packs application and relaxation therapy in pain during chest tube removal following cardiac surgery. N Am J Med Sci. Chest tubes in the critically ill patient. Dimens Crit Care Nurs. Kirkwood P. Chest tube removal perform. In: Wiegand DLM, ed. Louis, MO: Saunders; ; Angela C. Amy K. Save my name, email, and website in this browser for the next time I comment. Powered by www.
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American Nurse American Nurse. Sign in. Forgot your password? Get help. If there is a change eg. Haemoserous to bright red or serous to creamy, notify medical staff. Air Leak bubbling An air leak will be characterised by intermittent bubbling in the water seal chamber when the patient with a pneumothorax exhales or coughs The severity of the leak will be indicated by numerical grading on the UWSD 1-small leak 5-large leak Continuous bubbling of this chamber indicates large air leak between the drain and the patient.
Check drain for disconnection, dislodgement and loose connection, and assess patient condition. Notify medical staff immediately if problem cannot be remedied. This will diminish as the pneumothorax resolves. Watch for unexpected cessation of swing as this may indicate the tube is blocked or kinked Cardiac surgical patients may have some of their drains in the mediastinum in which case there will be no swing in the water seal chamber.
Consider converting to a portable flutter valve system such as the pneumostat to facilitate this. If chest drain will be required for prolonged period If a patient is on strict bed rest or is an infant, regular changes in position should be encouraged to promote drainage, unless clinical condition prevents doing so Patient Transport If the patient needs to be transferred to another department or is ambulant, the suction should be disconnected and left open to air.
If using the patient tube clamp the tubing then use a 20 gauge needle with syringe to aspirate specimen. Place fluid in sterile specimen container Once the syringe is disconnected remove all clamps and kinks Perform hand hygiene Chest Drain Dressings Dressings should be changed if: no longer dry and intact, or signs of infection e.
Accidental disconnection. Insert the tubing into the new chamber until you hear it click. Unclamp the chest drain Check drain is back on suction Place old chamber into yellow infectious waste bag and tie Perform hand hygiene Splitting the UWSD Chambers Indications When 2 chest drains are connected via a Y-connector into 1 drainage chamber there may be a need to have them split into 2 chambers to determine if 1 drain is draining more than the other Equipment Required New UWSD Dressing pack Gloves Eye Protection Chlorhexidine Scissors Connector Cable tie wraps Cable tie gun Procedure also see figure below See Aseptic Technique Policy and Procedure Perform hand hygiene Use personal protective equipment to protect from possible body fluid exposure Place newly prepared drainage system in a position adjacent to the old system as set up as per chest drain set up.
Once the required drains are removed, unclamp remaining drains Remove disposable gloves, perform hand hygiene and don sterile gloves Place sterile towel under tubes Clean around catheter insertion site and cm of the tubing with age appropriate skin cleaning solution If purse string present cardiac patients unwind in preparation for assistant to tie Remove suture securing drain ensuring purse string suture not cut Instruct patient exhale and hold if they are old enough to cooperate; if not, time removal with exhalation as best as possible.
Pinching the edges of the skin together, remove the drain using smooth, but fast, continuous traction. The assistant pulls purse string suture closed as soon as the drain is removed, tying 2 knots and ensuring the suture is not pulled too tight. Cut tails of suture about 2cm from knot If there is no purse string present remove drain and quickly seal hole with occlusive dressing Instruct patient to breathe normally again Apply occlusive dressing bandaid for cardiac children over site Remove and discard equipment into a yellow infectious waste bag and tie Perform hand hygiene Post Procedure Care Attend to patients comfort and sedation score as per procedural sedation guideline CXR should be performed post drain removal Patients in PICU may wait until routine daily CXR if clinically well Clinical status is the best indicator of reaccumulation of air or fluid.
Clean ends of drain and reconnect. Ensure all connections are cable tied. If a new drainage system is needed cover the exposed patient end of the drain with sterile dressing while new drain is setup. Ensure clamp removed when problem resolved Check vital signs Alert medical staff Accidental drain removal Apply pressure to the exit site and seal with steri-strips.
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