Chest Tube Drainage Systems Flashcards
Indications for Chest Tube
- Closed Pneumothorax
- Blunt trauma closed Pneumothorax
- Tension Pnuemothorax
- Open Pneumothorax
- Pleural effusion
Less than 20% Pneumothorax Tx
- complete bed rest
- limited activity
- possible supplmental O2
More than 20% Pneumothorax Tx
- Thoracentesis
- Chest tube placement
Nursing Responsibility for
- identify patients at risk
- assess decreased breath sounds on one side
- assess SOB
- note lack of chest movement on effected side
- desaturation on pulse ox
Chest Tube Locations for removal of air
-high lateral chest
Chest Tube Locations for removal of fluid
- low lateral chest
- low posterior chest
Chest Tube Locations for removal of blood
-low (under the sternum) anteriorly
The Drainage System
- Three bottle system
- Pleur-evac system (3 chambers)
- Waterless drainage systems
All contain: drainage chamber, water-seal chamber, and suction chamber
Chest Tube Sizes
Infants/young children: 8-12FR
Children/young adults: 16-20FR
Most popular adult size: 28-32FR
Large adult: 36-40FR
Chest tube insertion
- incision made at insertion site
- puncture into the pleural cavity
- chest tube inserted
- placed to pleural drainage system
- sutured into place
- drainage system hung below chest level
Once CT is in place…
- secure the connections
- dress the site
- place below the chest of the patient
- place to suction as indicated (slow, soft bubbling)
Daily assessment of the drainage system
S: Site - dressing, drainage
T: Tube - taped connections, dependent loops
O: Output - record q8h, document on I&O, excess, mediastinal should decrease over time
P: Patient - tidaling in water seal chamber
Only reason to clamp a CT
- changing the system
- assessing for an air leak
- assessing pt’s tolerance for removal
Dislodgement
- any disconnection should be immediately reconnected
- MD should be notified
- if fully pulled out: vaseline to site immediately, occlusive dressing, notify MD stat, Prepare for STAT xray, observe for S/S pneumothorax
