1. CHEST TUBES AND DRAINAGE SYSTEMS NURSING COMPETENCY
Presented by: Jonna Bobeck BSN, RN, CEN

2. Objectives Discuss anatomy and physiology of chest
Describe mechanics of breathing
Explain indications/contraindications
Discuss nursing care
Describe set up and monitoring
Understand water seal

3. Introduction

4. Anatomy of the Chest Visceral Pleura Parietal Pleura Lung Ribs
Intercostal Muscles

5. Why are the Lungs Expanded

6. Mechanics of Breathing

7. Indications: Pneumothorax/Hemothorax

8. Indications: Tension Pneumothorax

9. Indications: Other Conditions

10. Contraindications and Cautions
Be aware of hemodynamic status
Use of a trocar
Pneumothorax and air transport

11. How Water Seal Chest Drainage Units Functions

12. Fluid Collection

13. WATER SEAL
Safe
Cost effective
Measurement of intrathoracic pressure

14. Suction Control

15. Equipment

16. PREPARATION AND INSERTION
IV, O2, Monitor
Proper cleansing
Place patient supine
Administer antibiotics
Prepare drainage device
Tape or band connections
Apply occlusive dressing
Obtain CXR
Monitor

17. FOUR STEP SET UP: STEP 1

18. STEP 2

19. STEP 3

20. STEP 4

21. WHAT TO CHECK DURING SYSTEM OPERATION: SUCTION CONTROL STOPCOCK

22. WHAT TO CHECK CONTINUED
Verifying system operation
Placement of unit

23. PLACEMENT OF UNIT Place below patient’s chest
Use floor stand or hangers

24. OBSERVING FOR AIR LEAKS

25. SAMPLING PATIENT DRAINAGE

26. OBSERVING CHANGES IN PATIENT PRESSURE

27. HIGH NEGATIVITY FLOAT VALVE

28. MANUAL HIGH NEGATIVITY VENT

29. WHAT TO CHECK CONTINUED
Positive pressure protection
Adding water to water seal
Adding water to suction control
Suction greater than -20cmH20
How to lower suction control pressure setting
Recording drainage volume

30. IN-LINE PATIENT TUBE CONNECTORS

31. PATIENT TUBE CLAMP-

32. GRAVITY DRAINAGE AND SYSTEM DISCONNECT
Placement
Stopcock
Close slide clamp

33. AUTOTRANSFUSION CAPABILITY

34. WARNINGS AND PRECAUTIONS
Colleceted blood should not remain in chest drain for more than 6 hours
Keep patient tube clamp open during operation
Purge all air/do not administer entire contents
Citrate toxicity
Use a microemboli filter
Use hangers
Maximum infusion pressure 150 mmHg

35. SET UP ATS COLLECTION
Close chest drain ATS access line clamp and remove spike port cap. Insert ATS bag spike into access line of chest tube drainage system.
Position ATS bag below the base of the chest drain.
Open both clamps. Holding ATS bag below base of chest drain, bend ATS bag upward where indicated and it will pop open. Do not activate ATS bag prior to connecting chest drain.
When drainage has been collected Close ATS access line and ATS blood bag clamps.
Remove spike from ATS access line and recap ATS access line spike port and position access line in the holder located on top of the chest drain.
Keep ATS clamp fully closed at all time when not in use.

36. ATS BAG REINFUSION SET UP
Prime I.V. blood administration and microemboli blood filter with sterile saline.
Invert ATS bag with spike port pointing upward and remove cap using sterile technique.
Insert saline filter spike into ATS bag spike port.
Return bag to upright position and place on standard height I.V. pole.

37. TROUBLESHOOTING GUIDE
How to confirm airleak
Floatball is at the bottom of water seal column
Lowering water seal level
Water rises to the top of the water seal float valve
Tidaling of pressure ball

38. TROUBLESHOOTING CONTINUED
No bubbling in the suction control chamber
Vigorous bubbling noted in the suction control
Should suction control valve be turned off for transport?
should the manual vent be used during gravity drainage?
What to do if drainage system gets knocked over
drainage?
Should the manual vent be used during gravity
during gravity (no suction) drainage.
No. It is not recommended to depress the manual vent
After a chest drainage system has been knocked over,
can I use it and what should I do?
If the chest drainage system has been knocked over,
volumes. Atrium provides convenient, self-sealing
the water seal and suction control chambers for proper
set it upright and immediately check the fluid levels of
and syringe to adjust the water level in each chamber, if
diaphragms for access by a 20 gauge or smaller needle
seal or suction control chambers have an inadequate
aspirate any overfill that may have occurred. If the water
required. Alcohol swab the needle access area and
amount of blood has entered the water seal, it may be
fluid level, simply replace the lost volume. If a significant
advisable to change the system for a new one.

39. UNEXPECTED OUTCOMES Air leak Mediastainal shift Tube dislodgement
Substantial increase in bright red drainage
Loss of suction
Crepitus

40. DOCUMENTATION Patient and family education Reason for tube Assessment
Presence of fluctuation and bubbling
Amount of suction
Patient tolerance

41. OMG! LOOK AT THAT OUTPUT!

42. References
Atrium Medical Corporation, Initials. (2010). A personal guide to managing chest drainage. New Hampshire: Atrium Medical Corporation.