Instruments Station Flashcards
This is a trucut biopsy needle which is used to take histological specimens from lesions e.g. breast lumps or liver.
The needle is disposable with an outer cannula and inner, notched rod in which the tissue specimen is cut, trapped and withdrawn.
The procedure can be performed under local anaesthetic.
Central venous cannulas are inserted in the superior vena cava usually via either the internal jugular or subclavian veins.
They can be single or triple lumen lines. They are primarily used to measure the central venous pressure. They can also be used for the insertion of drugs e.g. amiodarone, dopamine or chemotherapy.
This is a temporary tracheostomy; it is an example of a definitive airway as it protects the patients lungs from aspiration.
One of the most common occasions you will see a tracheostomy is on a patient being ventilated on the intensive care unit.
A tracheostomy allows more efficient ventilation of the patient with a decreased dead space and also allows more effective suctioning of the airways. Tracheostomy can also be used in patients with upper airway obstruction or after laryngeal surgery
This is a thromboembolic deterrent stocking which should be used in all patients undergoing surgery and those who are immobile to help prevent deep vein thromboses.
They are available in different sizes and are used in conjunction with low dose subcutaneous heparin. They are contraindicated in patients with arterial disease of the lower limb.
Synthetic Absorbable Suture
This is an example of a synthetic absorbable suture which can be used for bowel anastomosis or tying off vessels.
Swan Ganz catheter
This is a Swan Ganz catheter which is used to measure the pressures in the heart, the pulmonary artery wedge pressure and can also be used to measure the cardiac output.
These are used in the intensive care setting and are typically inserted into a central vein.
Stiff Neck Cervical Collar
This is a stiff neck collar which is used to stabilise the cervical spine in a trauma patient when used in conjunction with 2 sand bags and tape.
They are sized by measuring the number of fingers from the clavicle to the angle of the mandible, and this is then compared to the measuring peg on the stiff neck collar.
Single Lumen CVP
Central venous cannulas are inserted in the superior vena can usually via either the internal jugular or subclavian veins.
They can be single or triple lumen lines. They are primarily used to measure the central venous pressure. They can also be used for the insertion of drugs e.g. amiodarone, dopamine or chemotherapy.
Silastic Urinary Catheter
This is a drainage type silastic Foley urinary catheter.
Silastic catheters are made of silicone and are more appropriate than latex one for long term catheterization.
Shouldered Syringe
This a syringe used for the injection of haemorrhoids with 5% phenol in almond oil.
The injection is performed in conjunction with a proctoscope. The injection is performed above the dentate line as it is insensitive.
Self Retaining Retractor
This is a type of retractor used to hold wounds open e.g. during a hernia repair or an appendicectomy.
Ryles NG Tube
This is a Ryles nasogastric tube which is primarily used for draining the stomach but can also be used to insert drug, feed or contrast into the GI.
After explaing what you are about to do to the patient , you will require a NG tube which has been in the fridge as it is stiffer, some lubricant, a bladder syringe , a drainage bag, litmus paper and tape.
The tip of the NG tube is lubricated and inserted into the nostril of the patient pointing it towards the occiput. The tube is then advanced as the patient swallows. The correct position of the tube is checked by aspirating gastric contents and checking for acidity on litmus paper, if this is unavailable then air can be inserted to the tube and the epigastrium auscultated for bubbling. Finally an x ray can be taken to identify the tube, however this is time consuming and often does not show the tube.
Once the tube is in the correct position a bag is attached and it is taped to the patients face.
Proctoscope is used to visualise the anal canal and lower rectum. It is also used when injecting or banding haemorrhoids.
After explaining the procedure to the patient, the patient is placed in the left lateral position and a digital rectal examination is performed. The proctoscope is then attached to a light source and lubricated prior to its insertion into the rectum.
Indications:
Diagnostic: rectal bleed, haemorrhoids, polyps, fistula in ano, carcinoma of anal canal
Therapeutic: haemorrhoids (injection scleropathy, cryo, therapy, banding, laser), polypectomy
Paediatric Oxygen Mask
It has a mask and a reservoir bag and an inlet to attach oxygen supply. I have seen this used in the management of a child with asthma. This system allows higher oxygen concentrations to be delivered than simple masks and negligible re-breathing of carbon dioxide.
Oropharyngeal Airway
This is used to provide an airway for a patient where there is an impaired level of consciousness.
It is sized my measuring the distance the from the angle of the mouth to the angle of the jaw. It is inserted into the mouth upside down and rotated within the oral cavity. It is inserted the correct way up in children.
Nylon Suture
This an example of a synthetic non absorbable monofilament suture. This suture can be used to close skin wounds.
Normal Saline
Normal (0.9%) Saline. Normal saline is an example of a crystalloid solution which contains 153mmol of NaCl.
It can be used to provide the normal daily fluid requirement for a patient or to replace additional losses e.g. vomit or diarrhoea.
Needle Holders
These are special forceps designed to hold the needle to allow the surgeon to suture accurately
They are held by the thumb and the ring finger. Alternatively they can be held ‘palmed’ to suture.
There is a ratchet mechanism to open and close the needle holders.
Nasopharyngeal Airway
This is a nasopharyngeal airway which is inserted into the nose using a rotational action.
It is used to provide an airway in people with a decreased level of consciousness or decreased gag reflex. The diameter tube should be sized against the patients own little finger distal phalanx. A safety pin is placed in the end of the tube to prevent it being inhaled.
Mannitol is an osmotic diuretic which can be used to lower raised intracranial pressure or drive the urine output in a patient with obstructive jaundice to prevent hepato renal syndrome.
Leg Bag
This is a leg bag which is attached to urinary catheter.
The Bag is strapped to the leg of the patient and is indicated for patients who are mobile and have either a short or long term indwelling urinary catheter.
e.g. A man who suffers with incontinence following sphincter damage after multiple TURPs.
Complications - The extra attachment for the catheter may lead to higher rates of infection, but complications have to be balanced with the extra freedom and privacy a patient will gain.
Laryngeal Mask
This is a laryngeal mask airway which can be used to provide an airway during short operations e.g. day cases. It does not protect the airway.
Laparoscopic Port
This is a Laparoscopic post which is used during Laparoscopic procedures e.g. Laparoscopic cholecystectomy.
These ports allow the surgeon to insert a telescope and instruments in the patient
Irrigation Urinary Catheter
This is a large bore irrigation type foley urinary catheter which is used to irrigate the bladder of patients at risk of clot retention e.g. after a TURP.
Intravenous Cannula is used to give intravenous fluids and drugs.
If you wish to give fluid quickly the cannula must be short and large bore e.g. grey or orange.
Method Aseptic technique
A tourniquet is applied, suitable vein localised, area cleaned and the cannula inserted until a flashback of blood is seen. The needle is then withdrawn whilst simultaneously advancing the cannula. Seal in place and flushed with normal saline. Document in notes.
Possible complications
Haematoma formation – due to vein puncture
Incorrect insertion – into subcutaneous tissue, when flushed the patient will feel pain and surrounding tissue will swell
Embolism – by air, thrombus or fragment of catheter breaking off and entering venous system
Phlebitis – inflammation of the vein resulting from infection or mechanical or chemical irritation
IM Femoral Nail
This is an intramedullary femoral nail which is used to internally fix femoral shaft fractures.
Interlocking screws are used to fix the nail. They are usually removed after 12 / 18 months.
Hip Replacement
This is the femoral part of a total hip replacement which articulates with an plastic acetabular cup.
The main indication for a hip replacement is pain from osteoarthtis of the hip.
Hickman Line
This is an example of a long term central venous line which is inserted in a similar way to a central line (usually subclavian).
The remnant of the line is tunnelled subcutaneously which decreases the incidence of line infection.
These are indicated for long term parenteral nutrition, long term intravenous antibiotic therapy and chemotherapy.
Comment Advantage of it is that insertion of this line would prevent repeated venepuncture with the attendant risk of painful extravasation and phlebitis
Hemiarthroplasty
This is a hemiarthoplasty hip prosthesis.
It is used in cases of intracapsular fractures of the neck of femur, as these fractures are prone to avascular necrosis of the femoral head.
Hartmann Solution
This is an example of a crystalloid solution, which contains sodium, chloride, bicarbonate and lactate.
It has a similar composition to the extracellular fluid.
It can be used to provide the normal daily fluid requirement of a patient or to supplement the patient for additional loses.
Hartmann’s solution is a favorite solution of anaesthetists and is the fluid advocated to be given initially in trauma in the Advanced Trauma and Life Support (ATLS) guidelines.
Gelofusin
This is 500ml of gelofusin which is an example of an artificial colloid solution.
Colloid solutions raise the plasma oncotic pressure and hence expand the intravascular compartment. There are other colloids and some available are natural e.g. albumin and blood. Colloids are useful in cases of shock e.g. due to sepsis or hypovolaemia.
Fracture Plate
This is a plate that is used in conjunction with screws to internally fix a bone fracture.
5% Dextrose
This is a bag of 5% dextrose, which can be used in conjunction with normal saline to provide the normal daily fluid requirement for a patient.
One litre of 5% dextrose contains 50g of dextrose in 1 litre of water.
It should be remembered that because the sugar in this fluid is metabolised to carbon dioxide and water you are essentially giving them water.
Feeding NG Tube
This is a feeding nasogastric tube (clinifeed tube) which is used to long term enteral nutrition in patients. It is thin bore and soft making it more comfortable for patients, it is also made of silastic which blocks less often.
After explaining to the patient what you are about to do the tube is inserted into the nostril after it has been lubricated. These tubes come with a wire inside them to aid their introduction, you advance the tube as the patient swallows. Correct position of the tube is checked by x-raying for the wire. When you are happy with the position of the tube the wire is removed and the feed attached in a sterile manner.
Endotracheal Tube ( a curved plastic tube; balloon cuff at one end, connector at the other) is used to provide a definitive airway for patients for example during long operations e.g. laparotomies and during cardiac arrests or trauma.
Method - The endotracheal tube is inserted using a laryngoscope, through the laryngeal folds. The end of the tube should lie just above the carina to allow ventilation of both lungs. After inserting the tube a balloon at the end of the tube is inflated with air through the blue side port. Position of the tube is checked by looking for symmetrical rising of the chest on ventilation breath sounds bilaterally and no gurgling over the epigastrium indicating oesophageal intubation. The tube is then tied into place.
Comment - It can be connected to oxygen supply.
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Disposable Rigid Sigmoidoscope is used for the inspection of the rectum and lower sigmoid colon.
Method - After explaining to the patient what you are about to do, you must attach a light source and a air pumping device. The patient is placed in the left lateral position and a digital rectal examination is performed. The sigmoidoscope is then lubricated with jelly and inserted pointing towards the umbilicus. Air is pumped into the rectum to allow you see the direction of the rectal lumen.
Biopsies can also be taken of rectal mucosa through the sigmoidoscope e.g. in a case of ulcerative colitis
Devers Retractor
This is a type of retractor which is used in open abdominal surgery to allow the surgeon to operate.
There are different sizes and types of retractors available, you may frequently be asked to use one during you clinical training when you are assisting in theatre.
Chest Drain Bottle
This is the bottle to which the chest drain is attached.
If you look carefully on these there will be a line called prime level which is filled with sterile water. The chest drain tubing is connected to a tube which is under the sterile water and therefore acts as a water seal.
After a chest drain has been inserted you can see bubbling in the water as the air leaves the pleural space. The chest drain bottle can also be used to collected blood, fluid and pus from the pleural space. The system can be driven by attaching suction to the top of the bottle making it an example of a active closed drainage system.
Catgut Suture
This is catgut suture, which is an example of a natural absorbable suture. Catgut has been replaced my many of the newer synthetic absorbable materials, however you will still see it being used in the formation of stomas and circumcisions.
Blood Culture Bottles
These are two blood culture bottles, one for aerobic bacteria and one for anaerobic bacteria. The blood is injected in a sterile manner into the bottles using a different needle from the one the blood was drawn with.
Blood cultures are a useful investigation in a case of pyrexia or suspected systemic sepsis.
Comment: Send blood for culture before starting antibiotics
Arterial Blood Gas Syringe is used to take samples to measure pH, PaO2, PaCO2, HCO3; Acidosis or alkalosis
Indications for use
Acute exacerbation of COPD, Asthma
Signs of CO2 retention
Unexpected deterioration in ill patient
Method for use
Before the procedure perform the Allen test:
The hand is elevated and the patient makes a fist, the ulnar and radial arteries are occluded, the hand is opened (appears blanched – pallor), ulnar pressure is released and hand color should return in <5sec, indicating sufficient collateral blood flow from the ulnar artery, therefore it is safe to cannulate the radial artery.
Palpate radial artery and clean the skin
Insert the needle at 45°C manipulate needle until flashback occurs
Arterial blood pressure will fill the syringe automatically
Remove needle, apply pressure and analyse blood in machine
Special features/ comment
Use femoral artery (mid-inguinal point and 2cm inferior)
Use brachial artery
This is an urometer which attaches to a catheter and is used to monitor urinary output hourly; as such it can provide a guide for fluid replacement.
This hard collar is used to stabilise cervical spine in a trauma patient in conjunction with 2 sand bags and tape (across chin and forehead).
Method of use
With the head stabilized in a neutral position (looking straight ahead), slide the collar behind the neck, position the chin notch to fit the chin, and fasten the velcro strap.
A nasal cannular is used to deliver O2 to a patient
Plastic tube fits behind the ears, and the prongs are placed in the nostrils. It is connected to an oxygen supply. The nasal cannula carries 1–4L/min, delivering 24% to 40% of oxygen.
Used in patients with normal vital signs, e.g. postoperative patient with slightly low oxygen saturations.
The simple face mask fits over the patient’s nose and mouth. It is used to deliver oxygen as the patient breathes through their nose or mouth. It has open side ports that allow room air to enter the mask and dilute the oxygen, as well as allowing exhaled carbon dioxide to leave the containment space. The plastic tubing is connected to an oxygen source.
Used for patients that require higher concentrations of oxygen but where controlled oxygen is not necessary, e.g. asthmatics, pneumonia, trauma.
The Venturi mask allows delivery of a fixed concentration of oxygen (FiO2) using the appropriate oxygen diluter jet and adjusting the oxygen flow to the appropriate level.
There are multiple venturi valves available in order to set the desired FiO2 and they are colour-coded (24% blue; 28% white; 35% yellow; 40% red; 60% green); e.g. it is used to deliver controlled oxygen therapy in COPD patients
The non-rebreathing mask has a reservoir bag, typically 1.5L that connects to an oxygen source. Before it is placed on the patient, the reservoir bag is inflated with oxygen, at a rate of 15L/min. Need to cover the valve. The patient inhales the air from the reservoir and it is replaced by the flow from the O2 supply.
Exhaled air is directed through a one-way valve on either side of the mask, which prevents the inhalation of room air and re-inhalation of exhaled air. The valve allows for the administration of high concentrations of oxygen, 60–90%.
It is commonly used in emergencies
Used during laparoscopic procedures e.g. laparoscopic cholecystectomy.
The ports allow the surgeon to insert, for example, a telescope in the patient.
Dacron graft frequently used for AAA surgery
Synthetic (Dacron, PTFE) vs natural (auto/allografts) grafts
Natural grafts can be used in situ with the valves surgically destroyed with intraluminal cutting valvutome. Alternatively the vein can be removed and reversed.
Below inguinal ligament natural grafts are better, but if no suitable veins use PTFE
Graft complications: occlusion, infection, distal embolisation, aorto-enteric fistulae
Used in patients presenting with nosebleeds
I have seen spinal needles used to perform a lumbar puncture on a child with suspected meningitis
Aseptic technique. Patient in the left lateral position, fully flexed (knees to chin) -> LA infiltrated -> 22G spinal needle is inserted between L3/L4. Feel resistance of ligamentum flavum, and then the dura, then a ‘give’ as the needle enters the subarachnoid space. Withdraw stilette -> wait for CSF à measure CSF ‘opening’ pressure with a manometer -> catch fluid in 3 plain sterile tubes and 1 fluoride tube (for glucose) -> re-insert stilette and remove needle
I have seen an epidural catheter used on my obstetrics rotation for pain relief during labour.
Same as for spinal needles but a Tuohy epidural needle is used instead. It has depth markings on it. When the needle enters the epidural space there will be a loss of resistance due to breaching the dense ligamentum flavum.
After placement of the Tuohy needle into the epidural space the catheter is threaded through the needle. The needle is then withdrawn over the catheter. The catheter is secured.
A Gabriel syringe is used for injection scleropathy of haemorroids with 5% phenol in almond oil or Arachis. The injection is performed in conjunction with a proctoscope. The injection is performed above the dentate line as it is insensitive
This is a 2-0 silk suture which is an example of a natural, non-absorbable, braided suture attached to a curved cutting needle. I have seen this used to close a skin wound in a patient that attended A&E.
The higher the number the thinner the suture
Face:3-5d, arms:7d, trunk:7-10d, lower limb:10-14d
Alternative methods of wound closure include steri-strips, staples and glue
This is a 3-0 synthetic, absorbable, monofilament suture attached to a straight needle. I have seen this used to close the abdominal wall after surgery/secure chest drain in position/for bowel anastomosis/tying off vessels.
This is catgut suture, which is an example of a natural absorbable suture. Catgut has been replaced by many of the newer synthetic absorbable materials; however you will still see it being used in the formation of stomas & circumcisions.
This is a Foley catheter - flexible tubes that are passed through the urethra into the bladder to drain urine. They are retained by means of a balloon at the tip which is inflated with sterile water.
Size given in French units (12-20)
Material: usually latex, silastic (silicone, for long term catheterization 12wks), silver alloy coating (↓ infection)
2-way: inflate balloon, drain urine into bag
3-way: + extra port for bladder irrigation fluid (image = large bore irrigation type foley catheter)
Indications for use
Monitor urine output
Relieve urinary retention
Pre- or post-op bladder drainage
Incontinent patients (long term catheterisation)
Used to irrigate the bladder of patients at risk of clot retention e.g. after a TURP
Instill drug therapy (BCG for bladder cancer)
Urodynamic investigations (insert contrast agent)
Method
Aseptic technique
Clean the genitalia and instill lidocaine 1-2% gel, the catheter is inserted until urine flows back. This ensures that it is in the bladder. Inflate the catheter balloon (check balloon capacity written on outer end).
Attach catheter bag.
Suprapubic insertion: aseptic, ensure bladder distended (full), clean skin, infiltrate with LA, nick the skin, insert trocar down vertically above pubic symphysis, when urine draining advance catheter over trocar and tape down securely
Comments
Foley catheter basically means it has a balloon.
Tell me about the sizes of catheters?
With regards to gauges of catheter – the higher the number the wider the lumen/thicker the catheter.
What other types of catheter do you know?
There is the more commonly used drainage catheter which can be inserted urethrally or suprapubically. This is for longer term use. I have seen it used in patients post-surgery and in patient whose urine output needs to be monitored.
Why would you need to measure urine output?
In circumstances of shock and hypovolemia where you are instigating fluid replacement it is often necessary to have a measure of output to balance fluid intake and output.
How does bladder irrigation work?
Bladder irrigation can either be continuous irrigation where bags of fluid drain into the catheter and fluid then drains from the bladder into a drainage bag, or it can be manual irrigation where fluid is inserted and then drained using a syringe.
How long to irrigate for?
Continue irrigating until the return fluid is clear, making sure the amount returned equals the amount instilled.
What is TUR syndrome?
Absorption of large amounts of irrigation fluid during the surgery through the open prostatic veins may cause hyponatraemia and confusion. Avoid by limiting the time of the surgery and using glycine instead of normal saline because it is absorbed less.
What to do if catheter is not draining?
Check for kinks
Ensure bag below level of bladder
Catheter is blocked: flush and withdraw 20mL of sterile 0.9% saline
Catheter slipped into proximal urethra: deflate balloon, advance and reinflate
Renal hypoperfusion: fluid challenge of 250mL Gelofusine STAT may help
This is a Foley catheter - silastic 2 way - Flexible tubes that are passed through the urethra into the bladder to drain urine. They are retained by means of a balloon at the tip which is inflated with sterile water.
Size given in French units (12-20)
Material: usually latex, silastic (silicone, for long term catheterization 12wks), silver alloy coating (↓ infection)
2-way: inflate balloon, drain urine into bag
3-way: + extra port for bladder irrigation fluid (image = large bore irrigation type foley catheter)
Indications for use - Monitor urine output
Relieve urinary retention
Pre- or post-op bladder drainage
Incontinent patients (long term catheterisation)
Used to irrigate the bladder of patients at risk of clot retention e.g. after a TURP
Instill drug therapy (BCG for bladder cancer)
Urodynamic investigations (insert contrast agent)
Method
Aseptic technique. Clean the genitalia and instill lidocaine 1-2% gel, the catheter is inserted until urine flows back. This ensures that it is in the bladder. Inflate the catheter balloon (check balloon capacity written on outer end). Attach catheter bag.
Suprapubic insertion: aseptic, ensure bladder distended (full), clean skin, infiltrate with LA, nick the skin, insert trocar down vertically above pubic symphysis, when urine draining advance catheter over trocar and tape down securely
Complications
Immediate:
Trauma if balloon inflated in urethra or force insertion
Poor drainage if catheter not correctly placed
Early:
Failure to retract skin -> paraphimosis
Bladder spasm may be painful, try reducing water in balloon
Late:
Infection -> patient deteriorates, fever, pain, change in urine colour
Urethral stricture
Rupture if output port blocked & fluid continues to run in
Comments
Foley catheter basically means it has a balloon.
Tell me about the sizes of catheters?
With regards to gauges of catheter – the higher the number the wider the lumen/thicker the catheter.
What other types of catheter do you know?
There is the more commonly used drainage catheter which can be inserted urethrally or suprapubically. This is for longer term use. I have seen it used in patients post-surgery and in patient whose urine output needs to be monitored.
Why would you need to measure urine output?
In circumstances of shock and hypovolemia where you are instigating fluid replacement it is often necessary to have a measure of output to balance fluid intake and output.
How does bladder irrigation work?
Bladder irrigation can either be continuous irrigation where bags of fluid drain into the catheter and fluid then drains from the bladder into a drainage bag, or it can be manual irrigation where fluid is inserted and then drained using a syringe.
How long to irrigate for?
Continue irrigating until the return fluid is clear, making sure the amount returned equals the amount instilled.
What is TUR syndrome?
Absorption of large amounts of irrigation fluid during the surgery through the open prostatic veins may cause hyponatraemia and confusion. Avoid by limiting the time of the surgery and using glycine instead of normal saline because it is absorbed less.
What to do if catheter is not draining?
Check for kinks
Ensure bag below level of bladder
Catheter is blocked: flush and withdraw 20mL of sterile 0.9% saline
Catheter slipped into proximal urethra: deflate balloon, advance and reinflate
Renal hypoperfusion: fluid challenge of 250mL Gelofusine STAT may help.
This is a Central Venous Catheterisation Set
A narrow flexible tube inserted in the superior vena cava usually via either the internal jugular or subclavian veins (in an emergency the femoral vein can be used)
They can be single or triple lumen lines
Indications for use: Administration of drugs, e.g. amiodarone
Long term parenteral nutrition
Long term IV antibiotics
To measure central venous pressure in acutely ill patients to quantify fluid balance and guide fluid replacement
Method: Aseptic technique, clean area
Assemble catheter & check patency by flushing with saline.
Identify insertion point, infiltrate lidocaine & introduce needle and syringe
Subclavian: 1cm below junction of medial 1/3 and lateral 2/3 of clavicle. Advance needle to the clavicle, once you hit it, move the needle under the clavicle and aim for opposite SCJ
IJV: lateral and parallel to carotid artery at the level of the thyroid cartilage, insert needle at 45° aiming for ipsilateral nipple US guidance!
Remove the syringe, keeping needle still and insert guide-wire, remove needle, never let go of the wire!
Feed the dilator over the wire, widen opening and remove
Feed catheter over the wire and into the vein
Remove the wire and check blood can be aspirated through each lumen
Flush each lumen, then stitch the catheter in place
CXR to check catheter position (at the level of the carina) and exclude pneumothorax
Possible complications:
Immediate:
Cardiac tamponade, arrythmias
Haemorrhage from artery puncture, e.g. carotid
Pneumothorax, haemothorax (CXR)
Phrenic nerve palsy – right phrenic nerve passes over the brachiocephalic artery, posterior to the subclavian vein, hiccups may be a sign of injury
Malposition
Early:
Air embolism
Thrombosis (high risk patients a continuous IVI of unfractionated heparin may reduce the risk)
Infection i.e. cellulitis
Late:
Sepsis
Blockage
A chest drain bottle is the bottle to which the chest drain is attached. I have seen this being used in during my respiratory attachment in the treatment of a persistent pneumothorax.
This bottle contains a line called prime level (500ml) which is filled with sterile water. The chest drain tubing is connected to a tube which is under the sterile water and therefore acts as a water seal. This means that air escapes from the pleural cavity on expiration but cannot be sucked back through the water seal on inspiration. Air bubbles into the water and then out into the atmosphere. The bottle is placed below the level of the chest to ensure that fluid does not reflux into the thoracic cavity.
After a chest drain has been inserted you can see bubbling in the water as the air leaves the pleural space.
The chest drain bottle can also be used to collect blood, fluid and pus from the pleural space.
The system can be driven by attaching suction – green (V) on top - to the top of the bottle making it an example of a active closed drainage system
Comments -
Watch out for:- Retrograde flow back into the chest (drain kept on the floor – gravity helps to prevent this)
Persistent bubbling – continual leak from lung?
Blockage of the tube from clots or kinking.
Malposition (check with CXR).
How can you check it is working?
Ask patient to cough – will see movement of the water.
