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Care of patient with chest drainage system

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nursing care of a patient who is having icd or chest drain

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Care of patient with chest drainage system

  1. 1. Care Of Patient With Chest Drainage System By: Mr. M. Shivanandha Reddy
  2. 2. What Is Chest Tube? • A chest tube is a catheter inserted through the thorax to remove air and fluids from the pleural space, to prevent air or fluid from re- entering the pleural space, or to Re-establish normal intrapleural and intrapulmonic pressures
  3. 3. Chest Tube
  4. 4. Indications: • Pneumothorax • Hemothorax • Pleural Effusion
  5. 5. Pneumothorax Air between the pleurae is a Pneumothorax • Occurs when there is an opening on the surface of the lung or in the chest wall — or both • The opening allows air to enter the pleural space between the pleurae
  6. 6. Hemothorax Blood in the pleural space is a Hemothorax
  7. 7. Pleural Effusion •Pleural Effusion –Transudate –Exudate –Empyema
  8. 8. Purpose Of Chest Tube Placement: 1. Remove fluid & air as promptly as possible 2. Prevent drained air & fluid from returning to the pleural space 3. Restore negative pressure in the pleural space to re-expand the lung
  9. 9. 1. Remove Fluid & Air As Promptly As Possible • Correctly positioned chest tube removes the fluid and air that is accumulated because of hemothorax or pneumothorax or pleural effusion
  10. 10. Prevent Drained Air & Fluid From Returning To The Pleural Space Chest tube is attached to a drainage device – Allows air and fluid to leave the chest – Contains a one-way valve to prevent air & fluid returning to the chest – Designed so that the device is below the level of the chest tube for gravity drainage
  11. 11. Restore negative pressure in the pleural space • Chest tube will be connected to a suction through 3 bottle system that maintains negative pressure in the pleural space
  12. 12. How A Chest Drainage System Works: • Expiratory pressure from the patient helps push air and fluid out of the chest (cough, Valsalva Manuer) • Gravity helps fluid drainage as long as the chest drainage system is below the level of the chest • Suction can improve the speed at which air and fluid are pulled from the chest
  13. 13. Types Of Chest Drainage Systems • The most commonly used drainage systems are: 1. One bottle / single bottle system 2. Two bottle system 3. Three bottle system
  14. 14. One Bottle / Single Bottle System
  15. 15. One Bottle / Single Bottle System • The simplest closed drainage system is the single chamber unit. • The chamber serves as a fluid collector and a water seal. • During normal respiration the fluid in the chamber ascends with inspiration and descends with expiration. • This is used for smaller amounts of drainage such as an empyema
  16. 16. Two Bottle System
  17. 17. Two Bottle System • The use of two chambers permits any fluid to flow into the collection chamber as air flows into the water-seal chamber. • Fluctuations in the water-seal tube are anticipated. • Two chambers allow for more accurate measurement of chest drainage and are used when larger amounts of drainage are expected.
  18. 18. Three Bottle System
  19. 19. Three Bottle System • When a volume of air or fluid needs to be evacuated with controlled suction, all three chambers are used. • Mark the suction control with centimeter readings to adjust the amount of suction. • Usually 15 to 20 cm of water pressure is used for adults
  20. 20. Pleuro Vac
  21. 21. Pleuro Vac
  22. 22. Precautions To Be Taken For A Patient With Chest Tube: • Keep a chest tube system closed and below the chest • The tube should be secured to the chest wall. • Watch for slow, steady bubbling in the suction-control chamber and keep it filled with sterile water at the prescribed level.
  23. 23. ……. Precautions • Make sure that the water-seal chamber is filled to the manufacturer specified level and watch for fluctuation (tidaling) of the fluid level to ensure that the chest tube and system are working. • Make sure connections are tight and taped • Report any unexpected cloudy or bloody drainage.
  24. 24. ……. Precautions • A constant or intermittent bubbling in the water-seal chamber indicates a leak in the drainage system, and the health care provider must be notified immediately. • Mark the level on the outside of the collection chambers every shift. • Do not let the tubing kink or loop, and ideally it should lie horizontally across the bed or chair before dropping vertically into the drainage device.
  25. 25. ……. Precautions • Encourage your patient to cough, deep breath, and use the incentive spirometer. • Make sure that he or she is frequently repositioned and ambulated if not contraindicated. • Routinely assess respiratory rate, breath sounds, SpO2 levels, and the insertion site for subcutaneous emphysema
  26. 26. ……. Precautions • Clamping a chest tube is contraindicated when ambulating or transporting a patient. Clamping can result in a Tension Pneumothorax • Handle the chest drainage unit carefully and maintain the drainage device below the patient’s chest.
  27. 27. If The Tubing Disconnects From The Drainage…… • Seal off insertion site – dry, sterile dressing or, petroleum gauze dressing • instruct the patient to exhale as much as possible and to cough. This maneuver rids the pleural space off as much air as possible. • Temporarily re-establish a water seal by immersing the open end of the chest tube into a container of sterile water
  28. 28. Termination of Chest Tube • Explain procedure to patient • Equipment – Suture removal kit, gloves, Vaseline gauze, – 4x4s, tape, towels • Tube should be pulled at the end of full inspiration. • Some physicians prefer coughing or holding breath to increase intrathoracic pressure • Occlusive dressing

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