1. CHEST TUBE
DRAINAGE

2. What IsChestTube?
• Achest tube is a catheter inserted through
the thorax to remove air and fluids from the
pleural space,to prevent air or fluid from re-
entering the pleural space,or toRe-establish
normal intrapleural and intrapulmonic
pressures

3. ChestTube

4. Indications:
• Pneumothorax
• Hemothorax
• Pleural Effusion

5. purposes
 It is used to remove air , fluid or p
u
s
.
 T
o establish normal negative
pressure in the pleural cavityfor
lung expansion.
 T
o equalize pressure on both sides
of the thoracic cavity
.
 T
o provide continuous suction to
prevent tension pneumothorax.

6. contraindication
 Bleeding diathesis
 Cardiac temponade
 Coagulopathy
 atelectasis

7. size of chest tube
•Adult male – 28-38fr
•Adult female – 28fr
•Child – 18fr
•Newborn – 12-14fr

8. • Confirm the procedure
• Inform patient
• Check for the consent
• Prepare the equipment
• X-ray
• Position patient
Pre procedure

9. during procedure
• Observe/monitor patient’s respiration
, saturation.
• Reduce patient’s anxiety.
• Prepare the under water seal.
• Connect the closed system fast

10. Post procedure
Monitor vital signs
• 15min x1 hour
• 30mins x1 hour
• 1 hour x4 hours and until stable
T
ake note of the respiration
• Rate Pattern
• Rhythm
 Check saturation
• Administer oxygen when necessary

11. Sitesfor chest tubeinsertion
• Thoracic surgery
• Anterior chest
• Posterior chest tube
• pneumothorax

12. How AChestDrainage System Works:
• Expiratory pressure from the patient helps
push air and fluid out of the chest (cough,
V
alsalvaManuer)
• Gravity helps fluid drainage as long as the
chestdrainagesystemisbelow the level ofthe
chest
• Suction canimprove the speed at whichair
and fluid are pulled from thechest

13. TypesOf ChestDrainage Systems
• Themost commonly useddrainagesystems
are:
1. Onebottle / single bottle system
2. Twobottle system
3. Three bottle system

14. OneBottle / SingleBottle System

15. OneBottle / SingleBottle System
• Thesimplest closed drainage systemis the single
chamber unit.
• Thechamber servesasafluid collector and a
water seal.
• During normal respiration the fluid in the chamber
ascendswith inspiration and descendswith
expiration.
• Thisisusedfor smaller amounts of drainagesuch
asan empyema

16. TwoBottle System

17. TwoBottle System
• The use of two chambers permits any fluid to
flow into the collection chamber as air flows
into the water-sealchamber.
• Fluctuations in the water-seal tubeare
anticipated.
• Twochambers allow for more accurate
measurement of chest drainage and are used
when larger amounts of drainage areexpected.

18. Three Bottle System

19. Restore negative pressure in the
pleural space
• Chesttube will be
connected to a
suction through 3
bottle systemthat
maintains negative
pressure in the
pleural space

20. Three Bottle System
• When avolume of air or fluid needs to be
evacuated with controlled suction, allthree
chambers are used.
• Mark the suction control withcentimeter
readings to adjust the amount ofsuction.
• Usualy 15 to 20 cmof water pressure is used
for adults

21. Pleuro Vac

22. Pleuro Vac

23. Post procedure
1. Care of patient
 Respiratory status
Auscultates lungs to assessair
lung
exchange in the affected
Place patient infowler’s
position

24. 2. Care of the wound
 Change the gauzewhen
necessary
Strict aseptic technique when
performing dressing
 Check skinintegrity
o Redness
o Sweling
o Loose suture

25. 3.Care of chest tube
Intact and taped
Maintain patency
Check forobstruction
Teach patient on how to take care of
the tubing
Place a pillow between patient and
tubing
Coil the tube
Avoid dependent loop
Instruct patient to cough if tube is
blocked
Milking and stripping of the tube
when blocked

26. 4.clamps
• Use rubber tips
• Clamped at the bedside
• Clamping
• During transfer
• Not more than 1 minute
• Upon doctor’s order
• Note: clamping chest tube wil accumulate in
the pleural cavity since the air has no means
of escape. Thiscan rapidly lead to tension
pneumothorax.

27. 5.Water seal
 Enhances flow from high to low.
 Place below patient’s chest wal
(gravity)
 Fill with sterile water.
 Rod must be immersed 2cm in
water.
 Observe for the fluctuationo
fwater
level.

28. 5(a) Fluctuation
 To ensure the patency of t
h
esystem
 It wil stop when :lung fuly expanded
an obstruction
• Check forobstruction
Tubing –kinked
Patient’s position
Ask patient to take a deep breath
and cough

29. 5(b) Bubbling
• Intermittent bubbling :normal
• Continuous bubbling :abnormal
• Check :Wound , Tube Connection
• If rapid bubbling without air leak :
inform doctor immediately

30. 5(c) Drainage output
 70-100 mls per hour
 observe for any change indrainage
colour.
 Mark theamount
Document in I/Ochart
Change bottle every24hrs when full

31. 6.Suction apparatus
 Low suction pump
 Must be controlled
 Suction valve / meter is inserted for wall
suction
 Check forbubbling
 Ifno bubbling
Clamp chest tube to check for air
leaks
Check tubing and connection
 Observe patient’s condition while chest tube
isclamped.

32. 7. Safety
1.Tube
 Prevent kinking
 Place a pillow as barrier
 Never clamp unnecessarily
2.Bottle
 Must be belowchest
 Keep bottle inbasin
 Inform relatives and housekeeping

33. 8.Ambulation
• Encourage patient to change
position to promote drainage
• No need to clamp the tube
• Maintain chest tubebelow chest
wall

34. 9. Exercise
Encourage deep breathing a
ndarm
exercise.
On the first post op day.
When patient not in severe pain.
Assist patient.
 To enhance the lungexpansion
 Prevent stiffness of thearm

35. 10.Comfort
analgesic inthe first
Administer
24hours.
Allow position that comfortable to
the patient .
Assist patient in daily living activity
Hygiene

36. Removal of chest tube
Assessment
X-ray done to check t
h
eprogress
Clamp for 2hours
Chest tube removed

37. Emergency care
• Bleeding
• Observe wound dressing
• Observe drainage
Dislodgement
• From insertion site :place a gauze
immediately
• From connection : clamp chest
tube immediately

38. Bottle breaks
 Identify either patient having
pneumothorax orhemothorax.
 Observe patient for ten
si
on
pneumothorax.
 Placetube in saline immediately.
 Unclamped immediately. (prevent
respiratory distress)
Elevation of bottle
Immediately informdoctor