Chest tubes

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Chest tubes

  1. 1. Chest Tubes A chest tube is a hollow plastic tube that is inserted into the chest cavity to remove or allow the drainage of fluid, blood, or air from that portion of the chest cavity They are removed when drainage becomes minimal Drainage is marked on the collection chamber and documented every 8 hours
  2. 2. Chest tubes (continued) WCMC uses the Atrium Oasis chest drain The Atrium Oasis chest drain is a disposable, dry suction operating system with 2100 ml collection volume, dry suction regulator, and calibrated water seal Dry suction chest drains require higher levels of vacuum pressure and air flow from the suction source For gravity drainage, disconnect the suction line and maintain drain below patient’s chest
  3. 3. Chest Tubes (continued) Highly visible suction monitor bellows (E) readily confirms suctions operation Large, easy-to-read collection chamber (D) numbers and graduations Chest drains include sampling port in patient tube (not pictured)
  4. 4. Chest tubes (continued) Ensure that the dressing is intact during assessment Medicate patients for pain as indicated - chest tubes are always uncomfortable and often painful Gentle rise and fall with inspiration and expiration within the water seal chamber (tidaling) is normal If bubbles are noted in the water seal chamber, check for an air leak Keep chest tube clamp & occlusive dressing at bedside Keep a straight path between the tubing and the patient to facilitate drainage Keep container for drainage below level of the patient’s chest in an upright position at all times
  5. 5. Chest tubes (continued)Chest tube initiation  Gather supplies (sterile gloves, suction equipment, chest tube, several towels and chest tube insertion tray) as ordered, place at bedside  Educate patient on procedure; have permit signed  Twist top off provided sterile water  Insert tip into suction port  Squeeze contents into water seal until fluid reaches 2cm fill line - water will tint blue for visibility  Position patient as instructed and assist physician in the insertion of the chest tube  Connect drain to patient prior to initiating suction
  6. 6. Chest tubes (continued)Chest tube initiation (continued) • Attach suction line to suction port on top of drain • Turn suction source on • Increase suction source vacuum to -80 mmHg or higher • Suction regulator is preset to -20 cmH2O o Adjust as ordered To avoid accidental turning over of the Atrium, place the unit on the floor or hang it at the bedside with the hangers provided Use needless luer port on patient tube connector for sampling when needed
  7. 7. Chest tubes (continued) Suction bellows will expand to the mark or beyond when suction is connected and operating at a regulator setting of - 20 cmH20 or higher If the bellows is expanded but less than the mark, increase the vacuum to -80 mmHg or higher For regulator settings less than -20 cmH20, any visible bellows expansion in bellows window will confirm suction operation Suction regulator is preset to -20 cmH20 To change setting, adjust rotary suction regulator dial
  8. 8. Chest tubes (continued) The water seal must be filled to the 2 cm fill line for system operation and air leak detection Once filled, water seal becomes tinted blue When air bubbles are observed going from right to left, this will confirm an air leak • Continuous bubbling confirms a persistent leak • Intermittent bubbling confirms an intermittent leak • No bubbling with minimal float ball oscillation will indicate no leak is present The air leak detector is gradual and ranges from 1 (low) to 5 (high)
  9. 9. Chest tubes (continued)Chest tubes are never emptied When the collection chamber is full or damaged, the entire drain is changed • Open the new chest tube drainage container • Fill water seal chamber to line with provided water • Set suction control regulator • Clamp the line with the attached clamp • Remove line from old drainage container • Insert line to new drainage container Check tube connections, water seal, suction regulator, and bellows often to confirm proper operation
  10. 10. Chest tubes (continued)Chest tube removal • Gather supplies (towels, suture removal tray, occlusive dressing, gloves) • Pre-medicate patient for pain and educate on procedure • Remove dressing and discard, noting drainage • Assist physician with procedure • Discard chest tube container and all tubing in a biohazard waste container • Document procedure and output

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