chest tubes and drainage systems nursing competency
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CHEST TUBES AND DRAINAGE SYSTEMS NURSING COMPETENCYPresented by: Jonna Bobeck BSN, RN, CEN
OBJECTIVES
Discuss anatomy and physiology of chest
Describe mechanics of breathing Explain indications/contraindications Discuss nursing care Describe set up and monitoring Understand water seal
INTRODUCTION
ANATOMY OF THE CHEST
Ribs
Intercostal Muscles
Lung
Visceral Pleura
Parietal Pleura
WHY ARE THE LUNGS EXPANDED
MECHANICS OF BREATHING
INDICATIONS: PNEUMOTHORAX/HEMOTHORAX
INDICATIONS: TENSION PNEUMOTHORAX
INDICATIONS: OTHER CONDITIONS
CONTRAINDICATIONS AND CAUTIONS
Be aware of hemodynamic status Use of a trocar Pneumothorax and air transport
HOW WATER SEAL CHEST DRAINAGE UNITS FUNCTIONS
FLUID COLLECTION
WATER SEAL
Safe Cost effective Measurement of
intrathoracic pressure
SUCTION CONTROL
EQUIPMENT
PREPARATION AND INSERTION
IV, O2, Monitor Proper cleansing Place patient supine Administer antibiotics Prepare drainage device Tape or band connections Apply occlusive dressing Obtain CXR Monitor
FOUR STEP SET UP: STEP 1
STEP 2
STEP 3
STEP 4
WHAT TO CHECK DURING SYSTEM OPERATION: SUCTION CONTROL STOPCOCK
WHAT TO CHECK CONTINUED
Verifying system operation Placement of unit
PLACEMENT OF UNIT
Place below patient’s chest Use floor stand or hangers
OBSERVING FOR AIR LEAKS
SAMPLING PATIENT DRAINAGE
OBSERVING CHANGES IN PATIENT PRESSURE
HIGH NEGATIVITY FLOAT VALVE
MANUAL HIGH NEGATIVITY VENT
WHAT TO CHECK CONTINUED
Positive pressure protection Adding water to water seal Adding water to suction control Suction greater than -20cmH20 How to lower suction control pressure setting Recording drainage volume
IN-LINE PATIENT TUBE CONNECTORS
PATIENT TUBE CLAMP-
GRAVITY DRAINAGE AND SYSTEM DISCONNECT
Placement Stopcock Close slide clamp
AUTOTRANSFUSION CAPABILITY
WARNINGS AND PRECAUTIONS
Colleceted blood should not remain in chest drain for more than 6 hours
Keep patient tube clamp open during operation
Purge all air/do not administer entire contents
Citrate toxicity Use a microemboli filter Use hangers Maximum infusion pressure 150 mmHg
SET UP ATS COLLECTION Close chest drain ATS access line clamp and remove spike
port cap. Insert ATS bag spike into access line of chest tube drainage system.
Position ATS bag below the base of the chest drain. Open both clamps. Holding ATS bag below base of chest
drain, bend ATS bag upward where indicated and it will pop open. Do not activate ATS bag prior to connecting chest drain.
When drainage has been collected Close ATS access line and ATS blood bag clamps.
Remove spike from ATS access line and recap ATS access line spike port and position access line in the holder located on top of the chest drain.
Keep ATS clamp fully closed at all time when not in use.
ATS BAG REINFUSION SET UP
Prime I.V. blood administration and microemboli blood filter with sterile saline.
Invert ATS bag with spike port pointing upward and remove cap using sterile technique.
Insert saline filter spike into ATS bag spike port.
Return bag to upright position and place on standard height I.V. pole.
TROUBLESHOOTING GUIDE
How to confirm airleak Floatball is at the bottom of water seal
column Lowering water seal level Water rises to the top of the water seal float
valve Tidaling of pressure ball
TROUBLESHOOTING CONTINUED
No bubbling in the suction control chamber Vigorous bubbling noted in the suction
control Should suction control valve be turned off for
transport? should the manual vent be used during
gravity drainage? What to do if drainage system gets knocked
over
UNEXPECTED OUTCOMES
Air leak Mediastainal shift Tube dislodgement Substantial increase in bright red drainage Loss of suction Crepitus
DOCUMENTATION
Patient and family education Reason for tube Assessment Presence of fluctuation and bubbling Amount of suction Patient tolerance
OMG! LOOK AT THAT OUTPUT!
REFERENCES Atrium Medical Corporation, Initials. (2010). A personal guide to
managing chest drainage. New Hampshire: Atrium Medical Corporation.
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