What are the Things to be Observed in Chest Drainage
Things to Observe in Chest Drainage
- Chest Drainage always keep the system closed and below chest level.
- Make sure all connections are taped and the chest tube is secured to the chest wall;
- Ensure the suction control chamber would be filled with sterile water to the 20 cm level or as doctors order.
- If using suction, make sure the suction unit’s pressure level causes slow but get steady bubbling in the suction control chamber;
- Always check the fluctuation (tidaling) of the fluid level in the water-seal chamber; it may cause, the system may not be patent or working properly, or the lung of the client may have re-expanded;
- Monitor constant or intermittent bubbling in the water-seal chamber, which indicates leaks in the chest drainage system. Try to correct external leak if you don’t then immediately inform the healthcare worker and correct it.
- Check fluid in the drainage collection chamber, the amount, colour, and consistency of drainage in the drainage tubing.
- Mark the chest drainage level on the outside of the collection chamber (with date, time, and initials) every 8 hours or more frequently if indicated. Report to consultant related to drainage which is excessive, cloudy, or unexpectedly bloody;
- 500ml to 1000ml of drainage may occur in first 24 hours after chest surgery, Between 100 and 300ml of drainage may accumulate during the first 2 hours; after this time the drainage should lessen.
- Teach and encourage the client to perform deep breathing, coughing, and incentive spirometry.
- Assist with repositioning or ambulation. Provide adequate analgesia as per order.
- Assessment of vital signs, breath sounds, SpO2, and insertion site for subcutaneous emphysema.
- At the time of chest tube removal, immediately apply sterile occlusive petroleum gauze dressing over the site to prevent air from entering the pleural space;
- Observe the drainage tubing, which should not be kinked, looped, or interfere with the client’s movement;
- Do not clamp a chest drainage tube, except momentarily when replacing the chest drainage unit, assessment of an air leak, or assessment of the client’s tolerance of chest tube removal, and during chest tube removal;
- Do not manipulate aggressively the chest tube; do not strip or milk it;
- Observe a client who is free from pain, an effective cough can be produced, will generate a much higher pressure than can safely be produced with suction;
- Suppose a patient cannot re-inflate his own lung, high volume, low pressure “thoracic” suction in the range of 15-25 cm of water could help;
- Clients who are on mechanical ventilators cannot produce an effective cough then suction is advisable;
- Trained nursing staff for close observation and identification of external leakage
- The water seal chamber and suction control chamber provide intra-thoracic pressure monitoring. In gravity drainage without suction the level of water in the water seal chamber = intra-thoracic pressure;
- Need to keep in mind is that, Slow, gradual rise in water level over time means more negative pressure in pleural space which signals healing. Goal is to return to −8 cm H2O;
- Application of suction: Level of water in suction control + level of water in water seal chamber = intra-thoracic pressure.
- To decrease resistance, first, tube is connecting drain to drainage bottles
- The capacity of volume of tube must be exceed ½ of client’s maximum inspiratory volume (otherwise water may enter chest)
- volume of water in second bottle should exceed ½ client’s maximum inspiratory volume to prevent indrawing of air during inspiration
- Chest drain should always kept at least 45cm below client bed (prevention of removed fluid or water refluxing into client chest)
- Always clamp chest drain when moving it.
- When suction is turned off, tubing must be unplugged so air can escape into atmosphere (otherwise client may land up a tension pneumothorax)