http://www.springnet.com/ce/s711a.htm#speeding
Pt. will present with two chest tubes, an anterior one near the apex of the lung to drain air and a posterior-lateral one near the base of the lung to drain fluid.
These tubes will come together in a Y-connector to a very long rubber tubing connecting to the water-seal chest drainage unit.
a. Look and listen for signs of respiratory distress and adequate level of oxygenation; control pain so that the patient will cooperate in TCDB to help reexpand the lung faster.
b. Have patient turn from back to affected side to promote drainage. Encourage arm exercises.
a. Is the dressing airtight and dry--is there any subcutaneous emphysema present in the tissue around the insertion site?
b. Are all the connections taped securely?
c. Is the tubing lying on the bed coiled without any dependent loops hanging down on the floor?
d. Is the drainage flowing freely down the tubes?
Gentle milking with gloved hands and K-Y jelly isusually allowed.
e. In the first chamber in the chest drainage setup--the drainage collection chamber--what is the nature of the drainage? How much per hour? Is it marked? Does the unit need to be changed?
f. Is there vigorous bubbling in the water seal chamber? If so,check for leaks in the system--start closest to the patient. Is the water level at 2cm? Is there 'tidalling" when the patient inhales(fluid rises) and exhales(fluid falls)? Is this normal?
g. Is the water level in the suction chamber at the proper level(usually -20cm)? Is the wall suction on to create only gentle bubbling in this chamber? When the patient is transported, can he be removed from suction? if so, the connection tube needs to be kept open to the atmosphere.
i. Is unit standing securely on the floor away from being "crushed" by changing the bed height?
j. Clamping, stripping, and irrigating:
Clamping the chest tube is not done except briefly to change the chest drainage container and to check for air leaks. The clamp needs to have rubber sleeves over its jaws so as not to damage the chest tube.
Stripping the tubes(with mechanical strippers) to promote drainage through them is not favored anymore as it causes high negativity within the chest cavity which may damage the tissue.
Irrigation is usually only done by the surgeon.
k. Dealing with emergencies:
CT is pulled out. . .
Drainage tube is disconnected inadvertently from the chest tube. . .
Tension Pneumothorax and Mediastinal Shift. . .
l. Assisting with removal of the chest tube
m. Teaching: May include site care, use and purpose of medications, need for rest, activity restriction, avoidance of people with infections.