nursing care of a patient who is having icd or chest drain

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

3. Chest Tube

4. Indications:
• Pneumothorax
• Hemothorax
• Pleural Effusion

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

7. Pleural Effusion
•Pleural Effusion
–Transudate
–Exudate
–Empyema

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

16. Two Bottle System

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.

18. Three Bottle System

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

20. Pleuro Vac

21. Pleuro Vac

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