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Care Of Patient With
Chest Drainage System
By:
Mr. M. Shivanandha Reddy
What Is Chest Tube?
• A chest tube is a catheter inserted through
the thorax to remove air and fluids from the
pleural space, to prevent air or fluid from re-
entering the pleural space, or to Re-establish
normal intrapleural and intrapulmonic
pressures
Chest Tube
Indications:
• Pneumothorax
• Hemothorax
• Pleural Effusion
Pneumothorax
Air between the pleurae is a
Pneumothorax
• Occurs when there is an
opening on the surface of
the lung or in the chest
wall — or both
• The opening allows air to
enter the pleural space
between the pleurae
Hemothorax
Blood in the pleural
space is a Hemothorax
Pleural Effusion
•Pleural Effusion
–Transudate
–Exudate
–Empyema
Purpose Of Chest Tube Placement:
1. Remove fluid & air as promptly as possible
2. Prevent drained air & fluid from returning to
the pleural space
3. Restore negative pressure in the pleural
space to re-expand the lung
1. Remove Fluid & Air As Promptly As
Possible
• Correctly positioned chest tube removes
the fluid and air that is accumulated
because of hemothorax or
pneumothorax or pleural effusion
Prevent Drained Air & Fluid From
Returning To The Pleural Space
Chest tube is attached to a drainage device
– Allows air and fluid to leave the chest
– Contains a one-way valve to prevent air & fluid
returning to the chest
– Designed so that the device is below the level of
the chest tube for gravity drainage
Restore negative pressure in the
pleural space
• Chest tube will be
connected to a
suction through 3
bottle system that
maintains negative
pressure in the
pleural space
How A Chest Drainage System Works:
• Expiratory pressure from the patient helps
push air and fluid out of the chest (cough,
Valsalva Manuer)
• Gravity helps fluid drainage as long as the
chest drainage system is below the level of the
chest
• Suction can improve the speed at which air
and fluid are pulled from the chest
Types Of Chest Drainage Systems
• The most commonly used drainage systems
are:
1. One bottle / single bottle system
2. Two bottle system
3. Three bottle system
One Bottle / Single Bottle System
One Bottle / Single Bottle System
• The simplest closed drainage system is the single
chamber unit.
• The chamber serves as a fluid collector and a
water seal.
• During normal respiration the fluid in the chamber
ascends with inspiration and descends with
expiration.
• This is used for smaller amounts of drainage such
as an empyema
Two Bottle System
Two Bottle System
• The use of two chambers permits any fluid to
flow into the collection chamber as air flows
into the water-seal chamber.
• Fluctuations in the water-seal tube are
anticipated.
• Two chambers allow for more accurate
measurement of chest drainage and are used
when larger amounts of drainage are expected.
Three Bottle System
Three Bottle System
• When a volume of air or fluid needs to be
evacuated with controlled suction, all three
chambers are used.
• Mark the suction control with centimeter
readings to adjust the amount of suction.
• Usually 15 to 20 cm of water pressure is used
for adults
Pleuro Vac
Pleuro Vac
Precautions To Be Taken For A Patient
With Chest Tube:
• Keep a chest tube system closed and below
the chest
• The tube should be secured to the chest wall.
• Watch for slow, steady bubbling in the
suction-control chamber and keep it filled
with sterile water at the prescribed level.
……. Precautions
• Make sure that the water-seal chamber is
filled to the manufacturer specified level and
watch for fluctuation (tidaling) of the fluid
level to ensure that the chest tube and system
are working.
• Make sure connections are tight and taped
• Report any unexpected cloudy or bloody
drainage.
……. Precautions
• A constant or intermittent bubbling in the
water-seal chamber indicates a leak in the
drainage system, and the health care provider
must be notified immediately.
• Mark the level on the outside of the collection
chambers every shift.
• Do not let the tubing kink or loop, and ideally
it should lie horizontally across the bed or
chair before dropping vertically into the
drainage device.
……. Precautions
• Encourage your patient to cough, deep breath,
and use the incentive spirometer.
• Make sure that he or she is frequently
repositioned and ambulated if not
contraindicated.
• Routinely assess respiratory rate, breath
sounds, SpO2 levels, and the insertion site for
subcutaneous emphysema
……. Precautions
• Clamping a chest tube is contraindicated when
ambulating or transporting a patient. Clamping
can result in a Tension Pneumothorax
• Handle the chest drainage unit carefully and
maintain the drainage device below the
patient’s chest.
If The Tubing Disconnects From The
Drainage……
• Seal off insertion site – dry, sterile dressing or,
petroleum gauze dressing
• instruct the patient to exhale as much as
possible and to cough. This maneuver rids the
pleural space off as much air as possible.
• Temporarily re-establish a water seal by
immersing the open end of the chest tube into
a container of sterile water
Termination of Chest Tube
• Explain procedure to patient
• Equipment
– Suture removal kit, gloves, Vaseline gauze,
– 4x4s, tape, towels
• Tube should be pulled at the end of full
inspiration.
• Some physicians prefer coughing or holding
breath to increase intrathoracic pressure
• Occlusive dressing
Care of patient with chest drainage system

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Care of patient with chest drainage system

  • 1. Care Of Patient With Chest Drainage System By: Mr. M. Shivanandha Reddy
  • 2. What Is Chest Tube? • A chest tube is a catheter inserted through the thorax to remove air and fluids from the pleural space, to prevent air or fluid from re- entering the pleural space, or to Re-establish normal intrapleural and intrapulmonic pressures
  • 5. Pneumothorax Air between the pleurae is a Pneumothorax • Occurs when there is an opening on the surface of the lung or in the chest wall — or both • The opening allows air to enter the pleural space between the pleurae
  • 6. Hemothorax Blood in the pleural space is a Hemothorax
  • 8. Purpose Of Chest Tube Placement: 1. Remove fluid & air as promptly as possible 2. Prevent drained air & fluid from returning to the pleural space 3. Restore negative pressure in the pleural space to re-expand the lung
  • 9. 1. Remove Fluid & Air As Promptly As Possible • Correctly positioned chest tube removes the fluid and air that is accumulated because of hemothorax or pneumothorax or pleural effusion
  • 10. Prevent Drained Air & Fluid From Returning To The Pleural Space Chest tube is attached to a drainage device – Allows air and fluid to leave the chest – Contains a one-way valve to prevent air & fluid returning to the chest – Designed so that the device is below the level of the chest tube for gravity drainage
  • 11. Restore negative pressure in the pleural space • Chest tube will be connected to a suction through 3 bottle system that maintains negative pressure in the pleural space
  • 12. How A Chest Drainage System Works: • Expiratory pressure from the patient helps push air and fluid out of the chest (cough, Valsalva Manuer) • Gravity helps fluid drainage as long as the chest drainage system is below the level of the chest • Suction can improve the speed at which air and fluid are pulled from the chest
  • 13. Types Of Chest Drainage Systems • The most commonly used drainage systems are: 1. One bottle / single bottle system 2. Two bottle system 3. Three bottle system
  • 14. One Bottle / Single Bottle System
  • 15. One Bottle / Single Bottle System • The simplest closed drainage system is the single chamber unit. • The chamber serves as a fluid collector and a water seal. • During normal respiration the fluid in the chamber ascends with inspiration and descends with expiration. • This is used for smaller amounts of drainage such as an empyema
  • 17. Two Bottle System • The use of two chambers permits any fluid to flow into the collection chamber as air flows into the water-seal chamber. • Fluctuations in the water-seal tube are anticipated. • Two chambers allow for more accurate measurement of chest drainage and are used when larger amounts of drainage are expected.
  • 19. Three Bottle System • When a volume of air or fluid needs to be evacuated with controlled suction, all three chambers are used. • Mark the suction control with centimeter readings to adjust the amount of suction. • Usually 15 to 20 cm of water pressure is used for adults
  • 22. Precautions To Be Taken For A Patient With Chest Tube: • Keep a chest tube system closed and below the chest • The tube should be secured to the chest wall. • Watch for slow, steady bubbling in the suction-control chamber and keep it filled with sterile water at the prescribed level.
  • 23. ……. Precautions • Make sure that the water-seal chamber is filled to the manufacturer specified level and watch for fluctuation (tidaling) of the fluid level to ensure that the chest tube and system are working. • Make sure connections are tight and taped • Report any unexpected cloudy or bloody drainage.
  • 24. ……. Precautions • A constant or intermittent bubbling in the water-seal chamber indicates a leak in the drainage system, and the health care provider must be notified immediately. • Mark the level on the outside of the collection chambers every shift. • Do not let the tubing kink or loop, and ideally it should lie horizontally across the bed or chair before dropping vertically into the drainage device.
  • 25. ……. Precautions • Encourage your patient to cough, deep breath, and use the incentive spirometer. • Make sure that he or she is frequently repositioned and ambulated if not contraindicated. • Routinely assess respiratory rate, breath sounds, SpO2 levels, and the insertion site for subcutaneous emphysema
  • 26. ……. Precautions • Clamping a chest tube is contraindicated when ambulating or transporting a patient. Clamping can result in a Tension Pneumothorax • Handle the chest drainage unit carefully and maintain the drainage device below the patient’s chest.
  • 27. If The Tubing Disconnects From The Drainage…… • Seal off insertion site – dry, sterile dressing or, petroleum gauze dressing • instruct the patient to exhale as much as possible and to cough. This maneuver rids the pleural space off as much air as possible. • Temporarily re-establish a water seal by immersing the open end of the chest tube into a container of sterile water
  • 28. Termination of Chest Tube • Explain procedure to patient • Equipment – Suture removal kit, gloves, Vaseline gauze, – 4x4s, tape, towels • Tube should be pulled at the end of full inspiration. • Some physicians prefer coughing or holding breath to increase intrathoracic pressure • Occlusive dressing