INTERCOSTAL DRAINAGE

1. CHEST TUBE DRAINAGE
[PLEUR EVAC]

2. Intercostal drainage is the insertion of
a tube into the pleural space to evacuate
air/ fluid, to help regain negative pressure
and thus promote lung expansion.

3. Clinical need for chest drainage :
When negative pressure in the pleural cavity
is disrupted by the presence of air and/or fluid
resulting in pulmonary compromise.
The purpose of a chest drainage unit is to
evacuate the air and/or fluid from the chest
cavity to help, re-establish normal intrathoracic
pressure

4. INDICATIONS
Pneumothorax
Closed Open

5. Hemothorax

6. Chylothorax
Pleural Effusion

7. Empyema
Cardiac tamponade

8. • Post operative cardiothoracic surgery
• Mechanically ventilated patients with any size of
pneumothorax/ haemothorax
• Respiratory distress or ventilator dependence
that does not permit thoracentesis.

9. PRINCIPLES
SUCTION [-20cm H2O]
WATER SEAL
GRAVITY
PRESSURE GRADIENT

10. EQUIPMENT
• A sterile flexible silicone or vinyl catheter.
• The proximal end of the tube has several eyelets
(small holes) to drain air and fluid & prevents
catheter from becoming occluded.
• A radiopaque stripe assists the verification of
placement on x-ray for maximum efficiency.

11. SIZE OF THE CHEST TUBE
The unit of chest tube size is French sizing, which
refers to circumference in millimeters.
According to the age,
Adult Male = 28-32 Fr
Adult Female = 28 Fr
Child = 18 Fr
Newborn = 12-14 Fr

12. CHEST DRAINAGE SYSTEM- TRADITIONAL

13. COMPARTMENTS

14. TUBE PLACEMENT
Pneumothorax - At the second or third ICS on the
mid-clavicular line or mid-axillary line. Size 16 to 24
Fr.

15. Haemothorax - At fourth to eighth (usually sixth to
eighth) ICS on the mid-clavicular or mid-axillary line.
Size 28 to 36 Fr.

16. Both air and fluid the two chest Catheters can be
joined externally with a Y-connecter.
Mediastinal chest tubes are inserted to remove air
and blood following cardiac surgery or chest
trauma.

17. ADVANCEMENTS IN CHEST TUBE DRAINAGE

18. WET SUCTION CONTROL SYSTEM

20. WET SUCTION CONTROL
Traditional chest drainage units regulate the
amount of suction by the height of a column of
water in the suction control chamber.
In wet suction control system [Pleurevac], fill
the suction control chamber to the desired height
with sterile fluid. Connect the short suction tubing
to a suction source, and adjust the source suction
to produce gentle bubbling in the suction control
chamber.

21. DRY SUCTION CONTROL

22. DRY SUCTION CONTROL
The dry suction units are controlled
by a self-compensating regulator. A dial to set the
suction control setting is located on the upper left
side of each unit.
To set the suction setting, rotate
the dial until the red stripe appears in the
semi-circular window at the prescribed suction level
and clicks into place.
In the presence of a large air leak, air flow
through the Pleur-evac may be increased by
increasing source suction.

23. ADVANTAGES OF DRY SUCTION SYSTEMS
• Higher suction pressure levels can be achieved,
• Set-up is easy
• No continuous bubbling, provides for quiet
operation
• No fluid to evaporate which would decrease the
amount of suction applied to the patient.

24. ONE WAY VALVE SYSTEM- GRAVITY

25. ONE-WAY VALVE
In the Pleur-evac Sahara, a one-way valve
replaces the traditional water seal. No water is
required to establish the one-way seal. Just connect
the patient tube to the patient’s thoracic catheter
and the patient seal is established for patient
protection. It works with the gravity support. It has
an airleak monitor.

26. SPICTRA- Chest / Thoracic Drain System
1-2 Litres capacity , disposable, automatic overflow
capacity with multiple chambers.

27. COMPLICATIONS
• Chest tube malpositions
• Re expansion pulmonary edema
• Infection of the skin site
• Pneumonia
• Shoulder disuse (frozen shoulder)
• High negative pressure due to
• The patient in respiratory distress, coughing
vigorously, or crying
• Chest tube stripping
• Decreasing or disconnecting suction

28. NURSING CONSIDERATIONS
RESPIRATORY STATUS
• Are there signs of respiratory distress or a change
from the baseline respiratory assessment?
CARDIAC STATUS(MEDIASTINAL TUBES)
• Are there signs of cardiac tamponade?

29. CHEST TUBE INSERTION SITE
• Is dressing clean, dry, and intact?
• Is there crepitus upon palpation around the site?
• Has the thoracic catheter been pulled out of the
chest?
PATIENT DRAINAGE TUBES
• Are all connections securely taped or banded
• Is the tube patent and free of
kinks?
• Are there any dependent loops in the tube?
• Is the clamp open?

30. COLLECTION CHAMBER
• What is the character of the drainage; is it bloody,
straw colored, or purulent?
• What is the rate of drainage?
• Has the drainage stopped suddenly?
• Are the columns only partially filled?
• Is the collection chamber full?

31. WATER SEAL CHAMBER
• Is the water level correct at 2 cm?
• Is the negative pressure indicator (YES) visible?
AIR LEAK METER
• Is there bubbling?
• Is the bubbling continuous or intermittent?
• If there is no bubbling, does the fluid move up and
down with respirations?
• Has water risen in the small arm of the water seal/air
leak meter?

32. WET SUCTION CONTROL
Is there continuous bubbling?
Is the chamber underfilled or overfilled?
DRY SUCTION CONTROL
Is the dial set at the prescribed suction?
Is the orange float present in the indicator window?
Does the water rise in the small arm of the air leak
meter when the dry suction setting is lowered?
GRAVITY DRAINAGE
Is the suction tube/port open?