Chest Tube Drainage

TERMS:
1. pnuemothorax- when the parietal or visceral pleura is breached
and the pleural space is exposed to positive atmospheric pressure

2. hemothorax- partial or complete collapse of the lung due to blood

accumulating in the pleural space; may occur after surgery or trauma

3. chest tubes- a catheter inserted through the rib space of the

thorax into the pleural space, commonly used after chest surgery and
lung collapse, t remove air and/or fluid, thereby restoring negative
pressure in the pleural space

4. thoracotomy- surgical opening into the chest cavity

ANATOMY of THORAX and PHYSIOLOGY OF RESPIRATION

In physiology, respiration is defined as the transport of oxygen from the outside
air to the cells within tissues, and the transport of carbon dioxide in the opposite
direction.

a. Ventilation, moving of the ambient air into and out of

the alveoli of the lungs.
b. Pulmonary gas exchange, exchange of gases between the
alveoli and the pulmonary capillaries.
c. Gas transport, movement of gases within the pulmonary
capillaries through the circulation to the peripheral capillaries in
the organs, and then a movement of gases back to the lungs along
the same circulatory route.
 d. Peripheral gas exchange, exchange of gases between the
tissue capillaries and the tissues or organs, impacting the cells
composing these and mitochondria within the cells.

DIFFERENT TYPES OF CHEST TUBE DRAINAGE

1. TRADITIONAL WATER SEAL
-has three chambers: a collection chamber, water seal chamber (middle
chamber), and wet suction control chamber
-requires that sterile fluid
-has positive and negative pressure release valves

2. DRY SUCTION WATER SEAL

-has three chambers: a collection chamber, water seal chamber (middle
chamber), and wet suction control chamber
-requires that sterile fluid be instilled in water seal chamber at 2-cm level
-no need to fill suction chamber with fluid, suction pressure is set with a regulator
-quieter than traditional water seal systems

3. DRY SUCTION
-also referred to as one-way valve system
-has one-way mechanical value that allows air to leave the chest and prevents air
from moving back into the chest
-no need to fill suction chamber with fluid thus, can be set up quickly in an
emergency

GUIDELINES IN CHEST TUBE CARE AND DRAINAGE

1. When using a chest drainage system with a water seal, fill the water seal
chamber with sterile water to the level specified by the manufacturer.
2. Mark the drainage from the collection chamber with tape on the outside of the
drainage unit. Mark hourly/ daily increments (date/time) at the drainage level.
3. Ensure that the drainage tubing does not kink, loop or interfere with the
patient's movement.
4. Encourage the patient to assume a comfortable position with good body
alignment.
5. Assist the patient with range of motion exercises for the affected arm and
shoulder several times daily.
6. Gently "milk" the tubing in the direction of the drainage chamber as needed.
7. Observe for air leaks in the drainage system
8. Observe and immediately report rapid and shallow breathing, cyanosis,
pressure in the chest or significant changes in vital signs.
9. Encourage patient to breathe deeply and cough at frequent intervals.
10. If patient is lying on a stretcher and must be transported to another area,
place the drainage system below the chest level.

NURSING RESPONSIBILITIES BEFORE, DURING AND AFTER CHEST TUBE

INSERTION:

BEFORE
-Prior to commencing chest tube insertion the procedure should be explained
fully to the patient and consent should be recorded.

DURING
-make sure the area to be incised is sterile
-remind the patient not to cough or move during the procedure

AFTER
- Assess patient for respiratory distress and chest pain, breath sounds over
affected lung area, and stable vital signs
-ensure that tubing is patent and connected securely
-keep system below the patient's chest level
-monitor characteristics of drainage including color, amount, and consistency