Chest Tube Drainage Systems

Question 1

INDICATIONS

Answer 1

• closed pneumothorax ( bleed, overinflated alveoli)
• blunt trauma closed pneumothorax (broken rib)
• tension pneumothorax( causes trachea to deviate toward unaffected side)
• open pneumothorax (bullet , knife wound)
• pleural effusion (fluid accumulates in plueral space)

Question 2

PNEUMOTHORAX TREATMENT

Answer 2

1. 20% pneumothorax
   - thoracentesis
   - chest tube placement

Question 3

NURSING RESPONSIBILITY

Answer 3

• identify pt at risk
• assess decreased breath sounds on one side
• assess shortness of breath
• Note lack of chest movement on effected side
• desaturation on pulse oximetry
• cyanosis

Question 4

CHEST TUBE LOCATIONS

Answer 4

1. removal of air
   - high lateral chest ( 2nd- 4th intercostal space)
2. removal of fluid
   - low lateral chest ( 5-7th intercostal space)
   - low posterior chest
3. removal of blood
   - low ( under the sternum ) anteriorly

Question 5

THE DRAINAGE SYSTEM

Answer 5

1. Three bottle system
2. Pleur- evac system
   - three chambers
   - collection chamber, red chamber( water seal), suction

Question 6

CHEST TUBE SIZES

Answer 6

• done at beside
• 8-12 fr ( infants , young children )
• 16-20 fr ( children, young adults)
• 28-32fr ( most popular adult size )
• 36-40 fr ( large adult sizes )
• pigtail chest tube is used to get rid of air about the size of infant tube

Question 7

CHEST TUBE INSERTION

Answer 7

• incision made at insertion site
• puncture into the pleural cavity
• chest tube inserted
• placed to pleural drainage system
• sutured into place
• drainage system hung below chest level

Question 8

CHEST TUBE SUTURES

Answer 8

“stay” normal suture- tied at all level of the skin and not as a purse string around the drain

“close” horizontal mattress suture- leave ends long and curl round drain so it can be readily , accessed to close the wound once the drain is removed

Question 9

ONCE IN PLACE

Answer 9

1. dress the site
   - cleanse site
   - Vaseline gause to stop air flow
   - occlusive dressing
   - dat e, time , initials
   - usually changed daily ( every 8 hrs)
2. place below the chest of the patient
3. place to suction as indicated
   - slow, soft bubbling
   - get chest xray to check for placement

Question 10

PATIENT ASSESSMENT

Answer 10

1. document procedure
   - site, location, tube size
2. assess immediately after insertion
   - respiratory status
   * breath sounds
   * respiratory pattern/ rate
   * pain
   * infection
   * SQ emphysema

3.done Q shift or PRN

Question 11

DAILY ASSESSMENT OF THE DRAINAGE SYSTEM

Answer 11

“S” -site
*dressing, drainage

“T” - tube
*taped connections, dependent loops

“O” - output

• record Q8hrs, document I&O, excess (>100ml/hr), mediastinal should decrease over time
• document any air leak

“P”- patient
*tidaling in water seal chamber

Question 12

TROUBLE SHOOTING

Answer 12

REMOVAL

• may clamp for several - 24 hours
• chest xray done

TRANSPORT

• maintain upright
• maintain below the heart
• order to remove from suction

PHYSICIANS REMOVE THEM !!!!

Question 13

TROUBLESHOOTING PT 2

Answer 13

CHANGING THE SYSTEM

• prepare new system (pleur-vac)
• clamp CT above connection
• remove old system and attach new system
• unclamp ASAP

DISLODGEMENT

• any disconnection should be immediately reconnected!
• MD should be notified
• if fully pulled out :
• Vaseline to site immediately
• occlusive dressing
• notify MD stat
• prepare for stat xray
• observe for s/s of pneumothorax

Question 14

ONLY REASONS TO CLAMP A CHEST TUBE

Answer 14

• changing the system
• assessing for an air leak
• assessing pt’s tolerance for chest tube removal