In maintenance of chest drainage, A chest tube is a flexible plastic tube, is inserted through the chest wall into the pleural space or mediastinum through the doctor.
Maintenance of Chest Drainage Tubes
- Ensure that the patient’s ICD drainage tubes are kept in a proper position.
- Ensure that the tubing’s do not loop or interfere with the movements of the patient.
- Ensure that the ICD bag is placed below the level of chest. In case of change of position, take care that the bag is not accidentally placed at a height above chest level.
- Keep two artery forceps ready in order to handle any accidental disconnection of the tube.
- Encourage good body alignment. When the patient is in a lateral position, place a rolled towel under the tubing to protect it from the weight of the patient’s body. Encourage the patient to change his position frequently.
- Encourage patient to do the range of motion exercise of the arm and shoulder of affected side.
- “Milk” the tubing in the direction of the drainage bag as needed.
- Ensure that there is fluctuation (Tidaling) of the fluid level.
- Empty out the contents every 24 hours preferably in the morning at 6 a.m. unless the doctor specifies not to empty out.
- Subtract the amount of normal saline instilled before recording the results.
- Refill the normal saline at the level of the marking and add few drops of Betadine in it for easy visibility of the fluid.
- Fluctuations of fluid in the tubing will stop when –The lung has re-expanded.
- The tubing is obstructed by blood clots or fibrin.
- A dependent loop develops.
- Suction motor on wall is not operating properly.
Removal of inter-costal drainage
Collect the following articles at the bedside –
- Sterile Gloves.
- Sterile Gauze.
- Betadine ointment and lotion.
- Scalpel Blade.
- Analgesic drugs, if ordered.
- Dressing tray.
- Explain the procedure to the patient.
- Give analgesia prior to procedure, if ordered.
- Provide privacy.
- Wear unsterile gloves and remove the dressing. Ask the patient to take a deep breath and hold the breath while the tube is being pulled out.
- After tightening the stitches apply Betadine ointment and apply dressing.
- Ask for chest x-ray.
- Replace the articles.
- Document the procedure in nurse’s notes.
- Any untoward reaction noted duration the procedure.