management of chest tube

7/18/2019 Management of Chest Tube

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Management of ChestManagement of Chest

Tube Tube



What is a chest tube?What is a chest tube?



A chest tube is also known as chestdrain or chest drainage tube.

It is a plastic tube that is put

through the side of your chest.It is placed to remove air, blood, or

uid from around your lungs or

heart.A procedure called a thoracostomy

is done to insert a chest tube.



!hy do we need a chest!hy do we need a chest

tube"tube" #ou may need a chest tube for anyof the following conditions$



1. Empyema: This is an abscess%infection with pus& that mayform in your pleural space.



2. Hemothorax: !hen blood leaksbetween your lungs and chestwall it is called a hemothora'. A

traumatic %forceful& chest in(ury,a tumor %growth& of the pleura,or bleeding problems may cause

a hemothora'.



3. Pleural efusion: !hen there ismore uid than there should bewithin the pleural space it is

called a pleural e)usion.



3. Pneumothorax: This is acondition where air escapes fromthe lung into the chest cavity. This

does not allow your lung to fullye'pand when you breathe. Thiscan happen with a traumatic chestin(ury. It can happen when there isan in(ury or damage that happensinside your chest %spontaneouspneumothora'&.



Types o chest raina!eTypes o chest raina!e

systemsystem



*ne+bottle system*ne+bottle system

*ne tube leads out ofthe bottle through theplug at the top, allowingair to open into theatmosphere. The system can also be

connected directly to thelow regulator suction ifnegative pressure isreuired to improvedrainage afterwards.



Two+bottle system Two+bottle system

*ne form of this systeminvolves separatedrainage-collection andwater seal units, with

air from the pleuralspace conductedthrough the tubing thatconnects the two

bottles and bubbles/through the water sealbottle and e'its to theatmosphere.



Three+ bottle system Three+ bottle system

A three bottlesystem contains acollection chamber,

an under waterseal 0 a suctionregulating device

to maintainconstant negativepressure.



"ursin! #ana!ement"ursin! #ana!ement

1ositioning The patient should be placed in asemi+recumbent position withregular position changes in orderto encourage drainage and preventsti)ening of the shoulder (oints. These might enhance breathingand e'pectoration, as well as

allowing full lung e'pansion andpossibly preventing complicationsof prolonged immobili2ation.



3rain patency The tubing should be lifted regularly to drainthe uid into the collection bottle if thecoilings cannot be avoided. 4eplacement oftubing is usually advised if blockage isdetected. Although clamping of drains arestill observed and practiced in cases wherethere are no longer any air leakage andwhen replacement of tubing or bottle isnecessary, this is not recommended in thema(or international guidelines.



*bservation1atient5s vital signs, respiratory rate,o'ygen saturation as well as the

presence of tidaling and bubbling inchest drainage system should beclosely monitored. Any deterioration or

distress of the patient should bereported to the doctors immediately.



1ain management There are currently no de6niteguidelines on pain assessment and

pain control with regard to chestdrainage. The pain could besubstantial and might a)ect

coughing, ventilation, sleep as wellas re+e'pansion of the lung.



4ecording and observing drainage The drainage system should be keptbelow the patient5s chest level to

prevent uid re+entering the pleuralspace. 7olume, color, tidaling,bubbling of drainage uid and level

of suction pressure should beregularly evaluated and recorded onpatient5s chest drain chart.



3rain security and wound management8sing of tape to secure connections hasbeen controversial with no apparent clearrecommandation. 9ome researchers

advocated that taping the connections canavoid potential disconnection but othersargued that taped tube may maskdisconnections. The use of transparent,

water+proof and secure tapings might benecessary in a busy and congested wardenvironment.



The insertion site should be checkedeveryday to ensure that the woundis dry and clean, with no loosen

sutures or visible side hole%s& ofchest tube %i.e. slipping out&.1resence of or increasing surgical

emphysema, pus, or e'cessivebleeding around insertion sitesshould also be noted.



1otentially dangerous1otentially dangerous

conditions that reuireconditions that reuire

urgent attentionurgent attention:arge amount of bubbling in the water

seal chamber, which might signify a large

patient air leak or a leak in a system.9udden or une'pected cessation of

bubbling, which may indicate a blockage

in the tubing.



:arge amount of bloody discharge mightindicate haemothora' or trauma tounderlying organ%s& Increasing dyspnoea, increased heart rate,

lowered blood pressure 0 low o'ygensaturation$ may signify recurrentpneumothora' %after drain removal& orinsu;cient drainage or tube blockage.

Absence of gentle bubbling in suction controlbottle- chamber may indicate disconnectionof the suction pressure or inadeuate suctionforce to counteract the large air leakage.



<=ursing management of chest drainsis important. A comprehensiveunderstanding of the operations of

the chest drain systems and areasreuiring special attention would beimportant to reduce the

complications arising from chesttube drainage.

management of chest tube

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