Chapter 6: Manage Chest Tube Drainage Systems
6.1 Introduction
- Learning Objectives
- Physiology of breathing and negative pressure
- Indications for chest tube placement
- Compartments of a chest tube drainage system
- Safety principles for chest tube maintenance
- Troubleshooting chest tube drainage systems
- Nursing assessments and interventions
- Managing and documenting complications
- Chest tube is a catheter for removing air, blood, fluids from pleural space
- Used for re-expanding collapsed lungs by returning negative pressure
- Nurses play an active role in managing chest tubes
6.2 Basic Concepts
Anatomy and Physiology
- Lungs are in the thoracic cavity, protected by the rib cage
- Diaphragm separates thoracic cavity from abdominal cavity
- Pleural Space: Between visceral pleura (lung) and parietal pleura (chest wall)
- Contains pleural fluid for lubrication during breathing
- Breathing Process: Inspiration (negative pressure) and expiration
Pleural Disorders
- Pneumothorax: Air in pleural space causes lung collapse
- Hemothorax: Blood in pleural space
- Other conditions: Pleural effusion, Chylothorax, Empyema, Hydrothorax
Chest Tube Placement
- Inserted into pleural space to remove air/fluid
- Location varies based on condition: Higher for air, lower for fluid
- Chest Tube Drainage System: Closed system to prevent backflow
- Must be placed below chest level
Chest Tube Drainage System Chambers
- Collection Chamber: Collects drainage, measures fluid
- Water Seal Chamber: One-way valve, indicates tidaling, checks for leaks
- Suction Control Chamber: Wet or dry systems, manages suction
Air Leak Monitor
- Used to measure degree of air leaks
- Bubbling indicates air leak, monitored by meter
Heimlich Valve
- Portable valve for air leak management
6.3 Nursing Responsibilities
Start of Shift
- Verify provider orders and chest tube settings
- Baseline vitals and respiratory assessment
- Pain assessment and dressing check
- Ensure system is upright and functioning
Throughout Shift
- Monitor respiratory status and drainage
- Check for air leaks or dislodgement
- Manage pain and encourage lung expansion exercises
6.4 Troubleshooting Problems
- Respiratory Distress: Maintain system integrity, provide oxygen
- Air Leak: Identify source, reinforce dressings, notify provider
- Dislodged Tube: Cover site, notify provider
- Drainage Issues: Monitor and notify if changes occur
6.5 Checklist: Manage Closed System
- Verify orders and procedure
- Gather required equipment
- Safety checks and assessments
6.6 Setup of Chest Tube Drainage System
- Obtain provider order
- Gather equipment
- Maintain sterile technique
- Properly fill chambers as per system type
6.7 Assisting with Placement
- Assess patient condition and prepare for procedure
- Identify nursing diagnoses
- Monitor post-procedure for complications
6.8 Assisting with Removal
- Prepare patient, assess lung re-expansion
- Provide support during procedure
- Monitor post-removal for complications
6.9 Documentation
- Record procedure details, patient response, and education
Key Terms
- Definitions of terms such as pneumothorax, pleural effusion, hemothorax, etc., explained for better understanding.
These notes summarize the key points regarding the management of chest tube drainage systems, nursing responsibilities, and troubleshooting. They provide a comprehensive overview of the procedures and care involved for patients requiring chest tubes.