Chest Tubes: Setup and Maintenance

[Music] to prepare for chest tube insertion get the chest tube box other than medications it contains everything that the practitioner will need prior to insertion set up wall suction using our standard section liner and tubing next we're going to prepare the chest during our standard chest drain is the atrium Oasis dry section water sealed chest drain as known as the atrium 3600 it's stocked in the chest tube box we also have the atrium 3650 which allows for auto transfusion and either can be ordered from SSP under chest tube drainage container remove the chest drain from the outer bag and perform hand hygiene according to the manufacturers recommendation remove the blue wrath using sterile technique remove the chest drain from the box and rotate the swing out stand so it can stand on its own now we will fill the water seal remove the prepackaged 45 milliliter antal of sterile water from the back of the drain twist off the lid and squeeze the entire ampule into the section port located on top of the drain this fills the water seal to the two centimeter line next when the practitioner is ready remove the tubing from the back of the drain you may be asked to remove the sterile cap and then hand the patient connector to the practitioner to be hooked to the thoracic catheter when indicated by the practitioner hook up the wall section to the section port of the chest drain at the wall section regulator turn on section and increase section to at least negative 80 millimeters of mercury you should see the orange section monitor bellows expand beyond the triangle mark in the section monitor window indicating that section is working the chest drains dry section regulator is preset to negative twenty centimeters of water although it can be adjusted from negative 10 to negative 40 using the rotary dial on the side of the drain do not adjust this regulator setting unless ordered by the practitioner remember to keep the chest drain below the level of the chest at all times you can sit it on the floor using the swing out floor stand or using the multi position hangers you can hang it from the bed frame assess the dressing to make sure it is dry and occlusive inspect the skin for signs and symptoms of infection and palpate surrounding skin to identify subcutaneous emphysema remove any dependent loops from the tubing by looping it on the better chair this allows gravity drainage and prevents pressure from building up in the pleural space next assess the quantity and quality of fluid in a collection chamber clearly mark the level of the fluid and mark the date and time next assess for an air leak by looking for bubbling in the water sealed chamber bubbling indicates there is an air leak somewhere in the system it could be at the patient insertion site and the tubing or tubing connection or a crack in the chest drain itself the graduated markings help to quantify the size of the air leak from one of the lowest two five at the highest bubbling maybe continuous or intermittent if it's a new air leak you need to identify the source of the air leak and fix it if possible to locate the air leak briefly clamp the chest tube as a dressing if the bubbling stops you know the air leak is either at the insertion site or in the lung it so if bubbling continues briefly clamp the tube just distal to the first tubing connection if bubbling stops you know the air leak is in this connection try to seal it by reinforcing the connection if bubbling continues move down the tubing and clamp about every 12 inches or so to identify the source of the air leak if you get all the way to the drain itself and clamp and still have bubbling you know the air leak is in the chest drain itself you'll need to go ahead and switch out the chest drain keep in mind in this whole process when searching for the air leak never clamp the tubing for more than a couple of seconds or you risk a tension pneumothorax next check for titling titling is the up and down movement of the patient pressure float Bowl in the graduated water seal chamber with inhalation negative pressure increases and the float moves up and with exhalation positive pressure pushes the float back down with positive pressure ventilation titling will be just the opposite and this is normal you typically will not see titling with an air leak other reasons for no titling include a tubing occlusion the lung is fully expanded or peep which can dampen oscillation titling is more appearance when suction is turned off finally ensure that the drains dry section regulator is set to the right setting and that the orange suction monitor bellows is expanded to the triangle mark if the bellows is not expanded check that your suction tubing is connected and not obstructed ensure that the wall section regulator is on and turned up enough to expand the bellows if the order prescribes water seal it will disconnect the wall section from the suction port of the drain the orange suction bellows will no longer be expanded if the chest drain is full or has a crack in it you will need to replace it make sure you have the new chest drain open and ready for connection before clamping and disconnecting the old chest rain so switch the drains clamp the bloop tube clamp and disconnect the inline connector by pressing the Clear button quickly insert the tubing into the inline connector of the new chest stirring so that you hear a click indicating a good connection and immediately unclamp the blue patient tube clamp and verify that section is connected if you need to collect a sample of fluid there's a convenient sampling port here per policy clean for 15 seconds apply a sterile syringe and get your sample in the event of chest tube is dislodge from the patient's chest apply a sterile occlusive dressing and tape it on three sides do not take the fourth time to prevent increased lung tension if a connection is dislodged at any point below the insertion site place the end of the tubing and one to two inches of sterile water to re-establish a water seal [Music] you

Channel: Clinical Skills

Views: 846,307

Keywords: chest tube, thoracostomy, chest drain, atrium oasis

Id: Ui0eKmEk38M

Length: 6min 16sec (376 seconds)

Published: Tue May 09 2017