10.6 Chest Tube Drainage Systems
Chest tube dressing change Apply the split 4x4 gauze dressing/sponges Apply the split 4x4 gauze dressing/sponges around the chest tube so that the openings do not lie directly over one another. Lay two 4x4" gauze sponges over the sponges covering the chest tube. Chest Tube Dressing Change; Chest tube dressing change Gather materials. 2 -drain sponges according to patient size; 2 -4x4" gauze sponges; Chlorhexidine (ChloraPrep) or povidone-iodine swab sticks; 1 -5x9" Xeroform gauze for Trauma service patients; 1 -Tape 2"-4" Non-sterile gloves;.
The PleurX catheter system is designed to allow drainage of fluid that has accumulated in the chest or abdomen. A tunneled catheter is placed under the skin of the chest or abdomen, depending on where your fluid build-up is, and secured in place with a suture.
The catheter is what is the latin word for blue by your physician and can be done as an outpatient procedure PleurX drainage kit, A PleurX catheter is beneficial for patients who suffer from frequent pleural effusions or malignant ascites.
This system allows patients to drain fluid from the comfort of their own home and reduces the need for frequent trips to the hospital or doctors office PleurX drainage kit, dressnig You may shower with a water-proof dressing over your catheter.
If the gauze around your catheter becomes wet while showering change the dressing immediately. Unwrap the blue package being careful not to touch the items inside. These items are sterile and the blue wrapping will serve as your sterile field. Next remove the vacuum bottle from the plastic bag making sure the plastic shield covering the access tip of the catheter remains intact.
The vacuum bottle and catheter are sterile and it is important that the access tip of the catheter remain sterile. If the protective shield is missing from the access tip of the catheter do not touch the tip with hands or any item that is not sterile. Remove the 3 alcohol pads from the drainage kits and tear open leaving pad in packaging and place next to blue wrapping. From the unwrapped blue package yo up one glove by the wrist and place on the opposite hand. Pick up the second glove by the wrist and place on other hand.
These gloves are sterile and it is important that nothing touch the outside of the gloves, such as your skin. Open the package containing the valve cap and let the cap fall onto the sterile blue wrapping. Squeeze the clamp closed on the catheter of the vacuum bottle and place the access tip on the sterile blue wrapping. Remove the valve cap from eressing attached to your body and clean tip with alcohol swab.
Do not let anything touch valve after cleaning with alcohol swab. Insert the access tip of the vacuum bottle into the catheter valve until you hear a click. When you hear the click the access tip in completely attached. Cnest the bottle is full or there is no more fluid draining into the bottle, clamp the catheter tubing.
If you need to attach another vacuum bottle to drain more fluid remove the first bottle and repeat steps Remember- only drain ml or 2 bottles of fluid from the chest at a time or ml or 4 bottles of fluid from the abdomen at a time.
Clean the valve opening with a new alcohol swab. Place new valve cap on the end of the catheter and twist until it snaps locking the cap into position. Clean the skin around the catheter with a new alcohol swab. This blog is designed as an electronic source of education regarding the PleurX catheter system.
Your physician or healthcare ddressing should have already shown you how to care for your pleurX catheter and if you have any questions or concerns you should contact them how much it costs to cut down a tree. Anyone can use this blog for education on the use of a PleurX catheter including patients, family members, and healthcare workers.
A blog can be utilized by many different people and access is not limited to only certain users. Blogs are used as a form of sharing information of interest or educational what is a uterine polyp that the jow finds useful or meaningful.
But for those who prefer macromedia flash how to use use electronic sources for information and appreciate others points-of-view and helpful tips, blogs are a great resource to utilize. However, this is only to be used as a resource after your physician or healthcare provider has discussed your PleurX catheter with you. Hebda, T. PleurX drainage kit.
Care Infusion Corporation. PleurX drainage kit: Frequently asked questions [phamplet]. What is a PleurX catheter? Why do I need a PleurX catheter system? Helpful tips for taking care of a PleurX catheter. You will drain the fluid as directed by your doctor-typically every one to two days. Do not drain more than ml from your chest or ml from your abdomen at a time.
You will apply a new dressing over the tail of the catheter each time you drain fluid. PleurX drainage kit: Frequently asked questions, How what is a multi- franchise dealer I drain a PluerX catheter?
Prepare a workspace that is clean and large enough to place your supplies. Wash hands thoroughly using soap and water for at least 1 minute. Remove old dressing chdst catheter site.
Open drainage kit and place blue wrapped package on clean workspace. Undo the clamp to allow the fluid to drain into the bottle. Remove access tip from valve.
Place foam catheter pad on the skin around the catheter entrance site. Coil chqnge tubing and place on foam pad. Cover with gauze from kit and apply self-adhesive dressing over gauze. Remove rubber tubf cap from vacuum bottle and pour fluid into toilet and flush. Place bottle in plastic bag and discard.
PleurX drainage kit, What is the purpose of this educational blog? Who can learn from this blog? Why a blog? Is there something out there better than a blog? Add your thoughts here Email Required Name Required Website.
Chest Tube Dressing Change • Gather materials: • 2 -drain sponges according to patient size • 2 -4x4" gauze sponges • Chlorhexidine (ChloraPrep) or povidone-iodine swab sticks • 1 -5x9" Xeroform gauze for Trauma service patients • 1 -Tape 2"-4" • Non-sterile gloves • Sterile glovesFile Size: KB. Welcome to the chest tube dressing change refresher. Please use the navigation below to advance to the next page. You may also click on the images to view them at a larger size. The chest tube dressing change module is also available as a PDF for printing. Chest Tube dressing change home | Previous | Next. Center for Professional Practice of Nursing. The Center for Professional Practice of Nursing strives to provide quality education to nurses and allied health professionals at UC Davis Health and throughout the community.
Download Article as PDF. CHEST thoracotomy tubes CTTs have been around for centuries, but not until the late s did they become standard of care for treating empyema, pneumothorax, hemothorax, hemopneumothorax, and pleural effusion. CTTs can be life-saving, but only if managed based on current best evidence.
Understanding CTTs begins with understanding how breathing works. Ventilation, a two-part process, begins with inhalation. The chest cavity expands, mostly through diaphragm contraction, lowering pressure inside the chest cavity and effectively creating suction. Air moves from the atmosphere of greater pressure and into the thoracic cavity, where pressure is lower. This is negative pressure ventilation. The second part of ventilation, exhalation , is passive as the diaphragm and other respiratory muscles resume their resting configuration.
The decreased size of the lungs reverses the pressure gradient, and air is forced out into the atmosphere. Between the outer lining of the lungs and the inner chest wall lies the pleural space, which normally is lubricated by pleural fluid in the amount of 0. When pleural integrity is breached, excess blood, serous fluid, or air accumulates.
An extreme case is tension pneumothorax, which is characterized by progressive accumulation and trapping of air in the pleural cavity, causing pressure buildup that obliterates space for adjacent structures lungs, vena cava, and heart. CTTs drain fluid and air in the pleural cavity to promote lung re-expansion.
When a provider orders a CTT, your responsibilities include verifying patient identification, ascertaining that informed consent has been obtained except in emergencies , and determining patient understanding of the procedure. Explain the procedure to the patient, assess his or her comprehension, answer questions within your purview, and allow the patient to express his or her anxiety. Taking these steps will improve patient cooperation during the procedure.
Anticoagulant use is a relative contraindication to CTT insertion, but the provider will weigh the risks and benefits. Gather supplies: As ordered by the provider, prepare the CTT insertion tray, tube, and drainage system.
See Small bore or large bore? For underwater seal CDUs, the most important preparation is filling the water seal chamber with sterile water or sterile normal saline to the prescribed level 2 cm. Antibiotic and pain prophylaxis: Antibiotic prophylaxis is recommended only for patients with traumatic chest injuries.
Site selection and imaging: CTTs are usually inserted in the 4th or 5th intercostal space just anterior to the midaxillary line. Guidelines indicate that the preferred patient position is semi-reclined at a degree angle, boosted by a small wedge or linen to fully expose the side to be operated on. Secure any other potential obstructions to the surgical site, such as a pendulous breast, before the procedure.
This allows maximal expansion of the lungs while exposing the midaxillary area. Aseptic technique: Guidelines recommend full aseptic technique, which includes skin cleansing, sterile gloves, drapes, and gowns. Securing the tube: After insertion, providers secure the CTT with heavy, nonabsorbable suture 0 or silk. Dressings and tape are helpful, but nothing secures a chest tube better than stitching it in place.
See Tape: A little goes a long way. Studies suggest that petroleum gauze macerates skin over time. Other dressing materials have been explored, including dry occlusive dressings, standard gauze, and transparent film. A randomized controlled trial by Gross and colleagues found no significant difference in the effectiveness of petroleum gauze, dry sterile dressing bordered gauze , and no dressing.
Transparent film can be used alone or as a secondary dressing to avoid using tape. It also allows better visualization of the CTT to monitor for tube migration. Insertion site dressings: The literature presents several ways of dressing a CTT insertion site, but little evidence supporting their effectiveness exists. See Insertion site dressing options. In most practice settings, the provider who placed the CTT selects the dressing. The nurse performs postinsertion dressing changes according to organizational policy.
In addition to suturing, a chest thoracotomy tube CTT should be secured with tape a few inches below the insertion site to prevent accidental dislodgment and dependent loops. The omental tape technique fastens the tube securely while allowing some distance between the skin and the tube to prevent kinking and tension at the insertion site.
In addition to being wasteful and unnecessary, excessive tape may impede chest wall expansion. It also can increase moisture collection between the skin and the adhesive, which may lead to infection.
CDUs are categorized according to size and their mechanism for preventing air and fluid from entering the pleura. Underwater seal CDUs are larger and have two chambers a drainage collection chamber and water seal chamber. See Underwater seal CDUs. One-way valve CDUs are smaller and more portable. See One-way valve CDU. The provider selects the appropriate CDU type for the patient by anticipating the amount of drainage and whether suction will be needed. Underwater seal chest drainage unit CDU design is based on the classic three-way bottle system, with three distinct chambers in a sterile, integrated system:.
A wet-suction CDU has a suction control chamber, while the dry-suction CDU replaces this with a regulator and suction monitor bellows. A CDU also has additional features such as an air leak monitor, needleless access port, and a positive pressure release valve.
See an image of a CDU at opentextbc. Underwater seal CDU Drainage collection chamber: Drainage collection chambers, which typically have a 2,mL capacity, have calibrations and numeric markings for measuring output.
Best practice is to mark the drainage level and write the date and time of each reading on the face of the CDU. The provider orders output monitoring frequency, but at a minimum, do it at the start and toward the end of your shift. Water seal chamber: The water seal chamber prevents atmospheric air from going into the pleural space.
Any air in the pleural space will drain through the CTT and pass through the collection chamber and into the water seal chamber, where it appears as intermittent bubbling. This is normal and expected.
Continuous bubbling in the water seal indicates an air leak. Check all connections for looseness and secure with tape. Complete absence of bubbling may indicate chest re-expansion or a system malfunction. Tidaling or oscillations also are observable in the water seal chamber and coincide with respirations. Tidaling is normal; its absence may indicate chest re-expansion. Suction control mechanism: CDUs can be used with or without suction, but all CDUs have built-in mechanisms to regulate the amount of suction being applied.
To apply suction, connect the CDU to a wall suction unit, and turn the gauge to no less than —80 mmHg medium suction setting. Note that not all of this —80 mmHg of suction goes into the patient. The amount of suction applied to the patient is regulated by the CDU, not the wall gauge. There are two suction control mechanisms—wet versus dry. Wet suction CDUs , which are more traditional, use the amount of sterile water added to the chamber to regulate suction.
As suction is applied, continuous bubbling occurs in the suction control chamber. Wet suction CDU disadvantages include:. Dry suction CDUs were created to improve wet suction systems. The water column is replaced by a knob and internal valves to control suction. The suction monitor bellows provide visual confirmation that suction is being applied. In cases of pneumothorax where only air and a scant amount of drainage are expected, one-way valve devices may be more practical.
Smaller, one-way valve chest drainage units CDUs are portable and more practical when only air or a small amount of drainage is expected. Monitor patient response. Focus your assessment on the patient, not the equipment.
Every 8 hours or as needed , inspect the CTT insertion site for drainage, subcutaneous emphysema, and tube migration. Maintain CTT and drainage system integrity. Any breach in the system—even a loose connection—can allow atmospheric air to get sucked into the thoracic cavity, causing patient harm.
Secure and monitor all points of connection. Activities of daily living ADLs such as bathing, repositioning and turning, and ambulating can loosen or dislodge CTT connections. Assist patients during any of these activities. Ensure continuous drainage by gravity. The whole system should be kept patent, and the CDU must be positioned lower than the insertion site. Clamping might also be done after pleurodesis, which is a procedure to mechanically or chemically obliterate the pleural space where fluid buildup emanates.
Clamping always requires a provider order. Pay attention to the water seal chamber. If you witness excess bubbling, assume that the seal is being breached and air is leaking. Check and secure all connections. Note that tidaling and intermittent bubbling are normal.
Intrathoracic pressure can be gauged by looking at the water seal chamber. Safety vents in CDUs dispel excess negative pressure and any buildup of positive pressure. Intrathoracic negativity can be damaging if it exceeds —20 cmH 2 O. It can be caused by respiratory distress, coughing, and crying, as well as activities such as stripping or milking the tube.
You can remedy persistently high intrathoracic negativity by manually pressing on the high-negativity vent at the back of the CDU. Important: This can be done only if suction is being applied.