chest tube

موضوع: chest tube السبت ديسمبر 03, 2011 2:13 am

purpose:

1. to remove air, fluids, or blood from the plrural space.

2. To restore negative pressure to the pleural space.

3. To re-expand a collapsed or partially collapsed lung.

4. To prevent reflux of drainage back into the chest.

• Documentation should include:

1. character and amount of drainage

2. presence or absence of bubbling or fluctuation in the water seal chamber

3. amount of suction applied to the system

4. patient’s respiratory response

5. condition of the chest tube insertion site dressing

6. pain medications, if given

7. any complications and the nursing action taken

8. patient’s response to the therapy

• Assessment of a Chest Tube

• S.T.O.P. Method

S=Site

• Check for subcutaneous emphysema

• Lung sounds bilaterally

• Dressing should be free of drainage and occlusive

• Availability of additional dressings and tape to maintain occlusiveness

T=Tubing

• Connections should be taped

• No dependent loops

• Should be secured to chest to prevent any

• traction or pulling directly on insertion site

• Should not be clamped

• Drainage system should be below the chest

• 2 rubber-tipped Kelly clamps

O=Output

• Monitor drainage, greater than 100ml/hour, call MD

• Check for bubbling in water seal chamber (may indicate air leak)

P=Patient

]• Drainage in tube and water seal chamber should fluctuate as patient inhales and exhales. This is also known as “tidaling”

• Water level in water seal and suction chambers should be at correct level. Need to refill if evaporates.

What you do if the drainage stop?

• It can be caused by accumulated clotted blood occluding the tube. This
can lead to life-threatening cardiac tamponade. To keep the tubes
patent, or to dislodge clots, gently milk the tube.

1. If the patient’s condition is deteriorating rapidly, follow the emergency procedures of milking/stripping to dislodge clots.

2. If the patient appears stable, make sure the unit is low enough so
gravity can assist drainage; raise the bed, lower the Pleur-evac or turn
the patient on his affected side.

3. Check tubing for kinks or bends. Make sure tube is not clamped.

4. If the drainage has been tapering off over the past few shifts, lack of drainage may be normal