2. What IsChestTube?
• Achest 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 toRe-establish
normal intrapleural and intrapulmonic
pressures
5. purposes
It is used to remove air , fluid or pus.
To establish normal negative
pressure in the pleural cavityfor
lung expansion.
To equalize pressure on both sides
of the thoracic cavity.
To provide continuous suction to
prevent tension pneumothorax.
7. size of chest tube
•Adult male – 28-38fr
•Adult female – 28fr
•Child – 18fr
•Newborn – 12-14fr
8. • Confirm the procedure
• Inform patient
• Check for the consent
• Prepare the equipment
• X-ray
• Position patient
Pre procedure
9. during procedure
• Observe/monitor patient’s respiration
, saturation.
• Reduce patient’s anxiety.
• Prepare the under water seal.
• Connect the closed system fast
10. Post procedure
Monitor vital signs
• 15min x1 hour
• 30mins x1 hour
• 1 hour x4 hours and until stable
Take note of the respiration
• Rate Pattern
• Rhythm
Check saturation
• Administer oxygen when necessary
12. How AChestDrainage System Works:
• Expiratory pressure from the patienthelps
push air and fluid out of the chest (cough,
Valsalva Manuer)
• Gravity helps fluid drainage aslong asthe
chest drainage system is below the level ofthe
chest
• Suction canimprove the speed at whichair
and fluid are pulled from thechest
13. TypesOf ChestDrainage Systems
• Themost commonly used drainagesystems
are:
1. Onebottle / single bottle system
2. Twobottle system
3. Three bottle system
15. OneBottle / SingleBottle System
• Thesimplest closed drainage system is the single
chamber unit.
• Thechamber serves asafluid collector and a
water seal.
• During normal respiration the fluid in the chamber
ascendswith inspiration and descendswith
expiration.
• This is used for smaller amounts of drainagesuch
asan empyema
17. TwoBottle System
• Theuseof two chambers permits any fluidto
flow into the collection chamber asair flows
into the water-sealchamber.
• Fluctuations in the water-seal tubeare
anticipated.
• Twochambers allow for more accurate
measurement of chest drainage and are used
when larger amounts of drainage areexpected.
19. Restore negative pressure in the
pleural space
• Chesttube will be
connected to a
suction through 3
bottle system that
maintains negative
pressure in the
pleural space
20. Three Bottle System
• When avolume of air or fluid needs to be
evacuated with controlled suction, allthree
chambers are used.
• Mark the suction control withcentimeter
readings to adjust the amount ofsuction.
• Usually 15 to 20 cmof water pressure is used
for adults
23. Post procedure
1. Care of patient
Respiratory status
Auscultates lungs to assessair
exchange in the affected lung
Place patient infowler’s
position
24. 2. Care of the wound
Change the gauzewhen
necessary
Strict aseptic technique when
performing dressing
Check skinintegrity
o Redness
o Swelling
o Loose suture
25. 3.Care of chest tube
Intact and taped
Maintain patency
Check forobstruction
Teach patient on how to take care of
the tubing
Place a pillow between patient and
tubing
Coil the tube
Avoid dependent loop
Instruct patient to cough if tube is
blocked
Milking and stripping of the tube
when blocked
26. 4.clamps
• Use rubber tips
• Clamped at the bedside
• Clamping
• During transfer
• Not more than 1 minute
• Upon doctor’s order
• Note: clamping chest tube will accumulate in
the pleural cavity since the air has no means
of escape. This can rapidly lead to tension
pneumothorax.
27. 5.Water seal
Enhances flow from high to low.
Place below patient’s chest wall
(gravity)
Fill with sterile water.
Rod must be immersed 2cm in
water.
Observe for the fluctuationofwater
level.
28. 5(a) Fluctuation
To ensure the patency of thesystem
It will stop when :lung fully expanded
an obstruction
• Check forobstruction
Tubing –kinked
Patient’s position
Ask patient to take a deep breath
and cough
29. 5(b) Bubbling
• Intermittent bubbling :normal
• Continuous bubbling :abnormal
• Check :Wound , Tube Connection
• If rapid bubbling without air leak :
inform doctor immediately
30. 5(c) Drainage output
70-100 mls per hour
observe for any change indrainage
colour.
Mark theamount
Document in I/Ochart
Change bottle every24hrs when full
31. 6.Suction apparatus
Low suction pump
Must be controlled
Suction valve / meter is inserted for wall
suction
Check forbubbling
Ifno bubbling
Clamp chest tube to check for air
leaks
Check tubing and connection
Observe patient’s condition while chest tube
isclamped.
32. 7. Safety
1.Tube
Prevent kinking
Place a pillow as barrier
Never clamp unnecessarily
2.Bottle
Must be belowchest
Keep bottle inbasin
Inform relatives and housekeeping
33. 8.Ambulation
• Encourage patient to change
position to promote drainage
• No need to clamp the tube
• Maintain chest tubebelow chest
wall
34. 9. Exercise
Encourage deep breathing andarm
exercise.
On the first post op day.
When patient not in severe pain.
Assist patient.
To enhance the lungexpansion
Prevent stiffness of thearm
35. 10.Comfort
Administer analgesic inthe first
24hours.
Allow position that comfortable to
the patient .
Assist patient in daily living activity
Hygiene
36. Removal of chest tube
Assessment
X-ray done to check theprogress
Clamp for 2hours
Chest tube removed
37. Emergency care
• Bleeding
• Observe wound dressing
• Observe drainage
Dislodgement
• From insertion site :place a gauze
immediately
• From connection : clamp chest
tube immediately
38. Bottle breaks
Identify either patient having
pneumothorax orhemothorax.
Observe patient for tension
pneumothorax.
Place tube in saline immediately.
Unclamped immediately. (prevent
respiratory distress)
Elevation of bottle
Immediately informdoctor
