Chest Drainage Flashcards
Pleural Space:
normal- always negative pressure
inspire: -8 to -10 cm H2O pressure
expire: -4 to -5 cm H2O pressure
purpose of chest tube/drain:
remove fluid and/or air (>15-20% lung collapse) due to: injury, impaired lymph drainage, lung abscess, pneumonia, and surgery
Chest tube insertion:
flexible plastic tube (28-32Fr), inserted usually 2nd ICS to 9th ICS, positioning (high fowlers), incision/stab wound, connection to drainage device, and sutured in place/occlusive sterile dressings
Pleural drainage system:
various commercial products available, drainage chamber capacity varies, drainage collection chamber is marked at end of shift (not empties), long term devices available (drainage collection chambers are emptied), and two types of suction control chambers (dry and water)
Pleural drainage: Wet system:
Three basic components: 1. Collection chamber 2. water-seal chamber 3. suction control chamber
Pleural drainage: Dry system:
Three basic components:1. collection chamber 2. air leak monitor, 3. suction control
nursing care priorities: (4)
- ensure integrity of the system
- promote comfort for patient
- ensure chest tube patency
- prevent complication
complications:
malposition - tube migration out of pleural space (CXR to verify), re-expansion pulmonary edema (w/drawl of >1000ml of fluid initially), infection, frozen shoulder (caused by guarding chest), pneumonia (deep/breath/cough), hypotension (to rapid of fluid loss).
Emergency situations:
Notify MD or rapid response team immediately: tracheal deviation (tension pneumo.), sudden onset dyspnea (SPO2 100 ml output/hr, if patient disconnects from drainage system, if ct drainage stops w/in 24 hrs.
Chest tube removal:
medicate 30 min. prior, instruct pt to take deep breath/exhale/bear down as to poop (valsalva maneuver), MD cuts suture & removes the tube, sterile occlusive dressing applied with airtight dressing, CXR to eval for pneumothorax/fluid, assess for respiratory distress and drainage.
Collection chamber (Wet system):
> fluid and air from chest cavity via chest tube
holds up to 2500 ml (system dependent)
Fluid stays in the compartment while air vents to a second compartment (water seal)
Water-seal chamber (wet system):
> acts as a one way valve (has 2 cm H2O)
initial bubbling with evacuation of pleural space
intermittent bubbling with exhalation, coughing, or sneezing until lung re-expanded
tidaling-reflects pressure in pleural space (think tide of ocean)
*inhalation: “fluid moves up”
*expiration: “fluid moves down”
no bubbling is lungs re-expanded or tubing obstructed
air exits the water seal & enters the suction control chamber
Suction control chamber (wet system):
> applies controlled suction regulated by the amount of water in the chamber (20 cm H2O)
connected to wall suction, chamber is vented to atmosphere
increase in wall suction (vacuum source) does not increase negative pressure
adding more H2O to chamber increases negative pressure*
gentle continuous bubbling occurs while unit is in use (expected with wet system)
Collection chamber (dry system):
> fluid and air from chest cavity
holds up to 2100 ml
vacuum indicator: a check mark symbol is visible in the vacuum indicator window; no check mark symbol indicates atmospheric pressure (no vacuum in the collection chamber)
fluid stays in compartment while air vents through a one way valve to a second compartment-air leak monitor
Air leak monitor (dry system):
> initial bubbling with evacuation of pleural space
intermittent bubbling with expiration, coughing, or sneezing
extent of air leak indicated by a scale using 1 (low) to 5 (high) - smaller the number the lower amount of a leak
as the lungs re-expand the number associated with bubbling decreases
intermittent bubbling confirms intermittent air leak
blue tint water (if filled with sterile water provided) provides enhanced visibility for air leak detection
