CHEST TUBE

Chest tubes (Bülau drain or an intercostal catheter) are long, semi-stiff, clear plastic tubes that are inserted into the chest, so that they can drain collections of fluids or air from the space between the pleura. If the lung has been compressed because of this collection, the lung can then re-expand.

INDICATION:

Pneumothorax: a collection of air in the pleural space. Hemothorax: a collection of blood in the pleural space, maybe from surgery,

maybe from a traumatic injury. Empyema: a pyogenic infection of the pleural space Pleural effusion: accumulation of fluid in the pleural space Hemothorax: accumulation of blood in the pleural space Hydrothorax: accumulation of serous fluid in the pleural space

Chest Drainage System

Chest tubes are attached to a closed drainage system so that normal pressures within the alveoli and the pleural cavity can be restored. These pressures are essential to adequate expansion and reinflation of the lung.

One-, two-, and three-bottle methods for providing a closed drainage system.

Purpose of Three way bottle chamber

1st: Drainage bottle - to collect any fluids that is coming back to the patient.2nd: Water seal bottle – allows air out of the patient but it does not allow the air to go back to the patient.3rd: Suction control bottle – control the amount of suction that goes to the patient.

Plastic Drainage System

a disposable underwater-seal unit designed for drainage of the pleural cavity; it has a graduated collection chamber, permitting immediate and accurate measurement of the amount of drainage from the pleural cavity via the chest tube.

Properly functioning plastic drainage system:

Gentle bubbling in suction control bottle Tidaling in water seal Consistency on drainage

Maintenance of the drainage system

1. The bottles and collection apparatus of the system must be kept below the level of the chest to prevent backflow.

2. The lumens of the tubes must be kept open to allow for drainage. If they are obstructed there will be no fluctuation of the fluid level in the glass tube that is connected to the chest tube at one end and kept under water in the bottle at the other end. In the Pleur-evac, the liquid in the chamber should rise on the right side and fall on the left side. If there is evidence that the system is not working properly, this must be attended to immediately. Occlusion of the tubes can lead to a buildup of air and fluids in the pleural cavity and creation of a tension pneumothorax.

3. The system must be a closed (airtight) system. There can be no leaks around connections, and the lower end of the glass tube must remain under water in the bottle.

The amount, color, and consistency of the fluid drainage should be checked at least once each hour for the first 24 hours after surgery. The chest tubes should be milked and stripped every one to two hours to assure patency and adequate drainage. The amount of air being removed is indicated by occasional bubbling in the water-seal chamber. Excessive bubbling may indicate air leaks in the tubing.

An important aspect of patient care is proper positioning to maintain adequate drainage. The positions allowed and the amount of mobility permitted will depend on the patient's surgical diagnosis, the placement of the tube(s), and preference of the attending physician. Frequent turning, coughing, and deep breathing are instituted on a regular basis to avoid serious pulmonary complications. An exception to the rule of turning is the pneumonectomy patient, who is placed in high Fowler's position and not turned for at least 24 hours after surgery. Chest PHYSICAL THERAPY and INTERMITTENT POSITIVE PRESSURE BREATHING (IPPB) treatments usually are ordered for all patients with chest tubes. Some patients may require a ventilator during the immediate postoperative period.

The patient is observed for signs of respiratory distress and a buildup of air and fluid within the pleural cavity. Early correction of this condition can prevent mediastinal shift. Other signals that demand immediate attention are persistent bubbling in the underwater seal (fluid should fluctuate in the tube as the patient breathes), a drainage through the tube that accumulates at a rate of more than 100 ml per hour, leakage of air at the junctions of the chest tube and tubing and bottles or self-contained unit, and a “putty” appearance caused by the leakage of air into subcutaneous tissues in the upper chest and neck. After a chest tube is removed, the wound is promptly sealed with a sterile petroleum jelly dressing to occlude the opening and prevent entry of air into the pleural space.

SUBMITTED BY:JANNIN MANABAT

BSN 4- B