Care of Chest tubes Closed Chest Drainage System VN 255

Thora-centesis: “chest-puncture ” Insertion of a needle into the pleural space to aspirate fluid (pleural effusion=fluid trapped pleural space) aspirate/or drain fluid, blood, air, or to inject medication. May be for (diagnostic-reasons), or for therapeutic reasons to “reduce respiratory distress” If a continuous drainage is required use a chest drainage system like a “Pleur-Evac” closed chest drainage system.

Thoracentesis: After this procedure: Physician applies petroleum-jelly based gauze over the insertion site and forms a tight occlusive dressing. Monitor VS, changes in respirations/SOB and a CXR post procedure to be sure the lung was not punctured during the procedure causing a “pneumo-thorax” or collection of air or gas trapped in pleural space=lungs to collapse!

At the bedside: Always keep 2 padded clamps- may be needed if the chest tubes accidentally become dislodged/disconnected from the tubing. Pleur-Evac system is the new modern closed drainage system that has evolved from older “3-bottle system”..works on same principle: 1=drainage collection bottle ( fluid/blood) 2=“water seal” bottle***** most important 3=suction bottle ( only if you need suction) otherwise suction chamber is left open or vented to allow air escape.

Closed-chest drainage system

3 bottle system: Suction bottle,Water-seal bottle, Drainage bottle

Closed-Chest drainage System “Pleur-Evac” drainage system A thoracentesis is preformed usually at bedside/surgery and a chest drainage system (Pleur-Evac) system is hooked up to allow for continuous drainage of either air, blood, or fluid. Often it is an Emergency situation If goal is to remove air?- upper anterior chest, 2-4 intercostal space (catheter is inserted) If goal is to remove fluid/blood?-lower lateral chest 8-9 intercostal space (catheter inserted)

Chest Drainage System “Pleur-Evac System” Once the tube/catheter is secure in the pleural space (by M.D.), nurse hooks up the Pleur-Evac system. Make sure all connections are secure (use adhesive tape to prevent a break in the system) and sterile petroleum- jelly based occlusive gauze/ dressing are applied over insertion site to prevent air leaks!

Closed Chest Drainage System “Pleur-Evac chest drainage system The whole system is based on maintaining a “Negative intra-thoracic pressure” so we need a water seal bottle/chamber ( bottle # 2) Each time client exhales=air is trapped in pleural space and it travels down the chest tube to water seal bottle/chamber under water and then bubbles up and out of the bottle! The water acts as a seal allowing air to escape from pleural space but preventing air from getting back into the lungs via negative pressure of inspiration!

Water seal bottle/chamber The water level in the water seal bottle/chamber will fluctuate gently up and down with each inspiration/expiration. This is called “tidaling” Only time tidaling should stop is 1.= when the lung is “re-inflated” and no longer requires a chest tube or 2.= if a problem occurs with the tubing (kinked, occlusion, breaks in the system) and should be checked ASAP! 3.=If constant or vigorous “bubbling” occur please check for a “leak” something is wrong

Closed Chest Drainage System Suction bottle/chamber (bottle #3) used to speedily re-inflate the lungs. Water is added to the bottle/chamber. Suction is applied. (the force of suction is solely dependent on amount of water in bottle not the amount of suction set on suction machine. If water evaporates=add more water to prescribed level of water. See gentle bubbling in suction bottle If vigorous bubbling=suction will not be maintained; did the water evaporate? Add prescribed amount. If suction not used: chamber is then left open to allow air to escape.

Closed Chest Drainage System: Drainage/Collection bottle/chamber (#1) Only used if drain fluid/blood pleural space. (pleural effusion, chest trauma, surgery). Drainage chamber is not emptied but just marked amount every shift on the bottle/chamber. Report any marked increases in bloody drainage/fluid. Recorded as “Output” Often when chamber is full; RN/M.D. will change out the closed chest drainage system (Pleur-Evac) with a new one.

Closed Chest Drainage System General guidelines: Check system for any breaks,cracks, kinks in tubing, or broken connections Auscultate lung sounds, any sudden SOB, dyspnea, pain, hear any “crepitous sounds= think …SQ emphysema?” hear & palpate for leakage of air into SQ tissue Tight occlusive dressing intact? Clamps at bedside? No dependent loops tubing? Is the drainage system below chest level? Check water seal chamber and or suction chamber for the correct amount of water in chambers? Any vigorous bubbling? leaks? Record drainage as output

Closed drainage system If client must be transported: suction is usually off and air is vented out. Tubing is not clamped for transport! If a tube accidentally pulls out=quickly place a tight occlusive dressing over the insertion site on the chest to prevent air from re-entering…follow hospital policy Process of “Milking and Stripping” tubes is controversial…follow hospital policy If time to D/C’d the Chest tube/closed drainage system= M.D. pulls tube out and tight occlusive petroleum-jelly based gauze is applied over insertion site: CXR done (check for pneumothorax d/t a puncture lung?), Monitor respirations & for crepitous?