Chest tubes and water seal drainage

Major objectives to patient care

1. maintain sterility of the system 2. keep the system patent; prevent tension pneumothorax 3. keep the system airtight; think of the chest drainage system as an extension of the pleural space

pneumothorax

air in the pleural space

tidaling

the fluctuating movement of fluid in water sealed tube

Nursing interventions

1. chest bottles must be lower than the person's chest, drainage is by gravity air and fluid must not be forced back into the chest 2. water seal bottle must be placed in a box or secure to the floor with tape 3. be sure the patient is not lying on catheters to occlude them, this would impair drainage and cause reflux 4. the patency of the chest tubes needs to checked frequently 5. milking of tubes is safer than striping 6. chest drainage systems must be kept air tight, all connections must be taped 7. encourage patient to cough and deep breath frequently to reexpand the lung 8. two rubber shod clamps must be kept at the bed side for emergencies only 9. tidaling stops when the lung is reexpanded or if the chest tubes are not patent. kinking. unkink them 10. continuous bubbling during inspiration and expiration indicates that the air is leaking into the drainage system or pleural cavity 11. when the lung is completely reexpanded, no air or fluid passes through the chest tubes 12. chest tubes may not be removed if they draining more than 50-70 cc of fluid or air leaks from blebs are present 13. drainage from chest tubes is measured once a shift and charted on the I and O 14. chest tubes may be clamped 24 hours prior to be d/c 15. chest x ray confirms reexpansion of the lung