NUR105 - Chest Tube

drainage collection chamber, water seal chamber, and suction control (wet or dry)

what are the three chambers of a chest tube drainage system?

Water seal

• create by adding sterile fluid to the water seal chamber

• up to the 2 cm line (may vary)

• allows air to exit from the pleural space on exhalation and stops air from entering the lungs with inhalation

how to maintain a water seal

• keep chamber upright and below the level of the chest tube

• monitor water level due to possible evaporation

• add fluid as needed

Wet suction

• amount of water added = the amount of suction

• usually - 20 cm H20

Dry suction

• regulator is set to the amount of desired suction

• usually -20 cm H20

Tideling

• normal finding

• movement of the fluid level with respiration

• spontaneous respirations = fluid levels rise with inspiration and sink with expiration

• mechanical respirations = fluid levels sink with inspiration and rise with expiration

• Cessation of this = obstruction within the system

Continuous bubbling in the water seal chamber

• abnormal finding

• indicates a air leak in the system

yes

a chest tube is inserted into the mediastinal space and no tideling or bubbling is noted, is this expected?

indications for chest tube insertion

pneumothorax, hemothorax, postoperative chest drainage, pleural effusion, and pulmonary empyema

Apex of the lung

where should the tip of the chest tube be if they are attempting to get air out of the pleural cavity?

base of the lung

where should the tip of the chest tube be if they are attempting to drain fluid out the pleural cavity?

every hour for the first 24 hours then once every 4 hours

How often should the amount of drainage be checked?

date, hour, and drainage level

what should be marked on the drainage container at the end of each shift?

excessive drainage or drainage that is cloudy or red

what type of drainage should be reported to the provider?

two enclosed hemostats, sterile water, and an occlusive dressing

what should be at the bedside for someone with a chest tube in place?

clamp, strip, or milk the tubing

What should you not do to a chest tube?

• this causes a high negative pressure and can damage lung tissue

immerse the end of the chest tube in sterile water to maintain the seal

what should you do if the chest tube drainage system is compromised?