is a flexible plastictube that is insertedthrough the side of thechest into the pleuralspace to reexpandthe lung.
Purpose Itis used to remove air , fluid or pus. To establish normal negative pressure in the pleural cavity for lung expansion. To equalize pressure on both sides of the thoracic cavity. To provide continuous suction to prevent tension pneumothorax.
Indication Pneumothorax: accumulation of air Pleural effusion: accumulation of fluid Chylothorax: a collection of lymphatic fluid Empyema: a pyogenic infection of the pleural space Hemothorax: accumulation of blood Hydrothorax: accumulation of serous fluid
Pre Procedure1. Confirm the procedure2. Inform patient3. Check for the consent4. Prepare the equipments5. X-ray (with the report to determine the affected lung)6. Position patient
Observe/monitor patient’s Respiration SaturationReduce patient’s anxietyPrepare the under water sealConnect the closed system fast
Post procedure Monitor vital signs 15min x 1 hour 30mins x 1 hour 1 hour x 4 hours and until stable Take note of the respiration Rate Pattern Rhythm Check saturation Administer oxygen when necessary
Post procedure1. Care of patientRespiratory status Auscultates lungs to assess air exchange in the affected lung Place patient in fowler’s position
Change the gauze when necessary Strict aseptic technique when performing dressingCheck skin integrity o Redness o Swelling o Loose suture
Intact and taped Maintain patency Check for obstruction 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
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.
3 principles of under watersealGravityWater sealSuction
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 fluctuation of water level.
5(a) Fluctuation To ensure the patency of the system It will stop when : lung fully expanded an obstruction Check for obstruction Tubing –kinked Patient’s position Ask patient to take a deep breath and cough
5(b) Bubbling Intermittentbubbling : normal Continous bubbling : abnormal Check : Wound Tube Connection If rapid bubbling without air leak : inform doctor immediately
5(c) Drainage output70-100 mls per hour observe for any change in drainage colour Mark the amount Document in I/O chart Change bottle every 24hours or when full
6. Suction apparatus1. Low suction pump Must be controlled Suction valve / meter is inserted for wall suction Check for bubbling If no bubbling Clamp chest tube to check for air leaks Check tubing and connection Observe patient’s condition while chest tube is clamped.
7. Safety1. Tube Prevent kinking Place a pillow as barrier Never clamp unnecessarily2. Bottle Must be below chest Keep bottle in basin Inform relatives and housekeeping
8. AmbulationEncourage patient to change position to promote drainageNo need to clamp the tubeMaintain chest tube below chest wall
9. ExerciseEncourage deep breathing and arm exercise.On the first post op day.When patient not in severe pain.Assist patient. To enhance the lung expansion Prevent stiffness of the arm
10. ComfortAdminister analgesic in the first 24hours.Allow position that comfortable to the patient .Assist patient in daily living activity Hygiene
Removal of chest tubeAssessment X-raydone to check the progress Clamp for 2 hoursChest tube removed
Emergency careBleeding Observe wound dressing Observe drainageDislodgement From insertion site : place a gauze immediately From connection : clamp chest tube immediately
Emergency care…Bottle breaks Identify either patient having pneumothorax or hemothorax. Observe patient for tension pneumothorax. Place tube in saline immediately. Unclamped immediately. (prevent respiratory distress)Elevation of bottle Immediately inform doctor