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Chest Tubes

Used to remove air or fluid to reexpand lung


Placement
Position
o Seated on edge of bed with arms supported on bedside
table
o Supine with midaxillary area exposed
o Sutured in with dressing on top
Removing air
o Air rises
o Placed higher in chest wall directed anteriorly and
superiorly
Removing fluid
o Placed lower
o Directed posteriorly and inferiorly (towards back and down)
Flutter or Heimlich valve
Has a one way flutter valve
Air can escape but not enter
o Air exits during expiration
o Valve closes when breathing in.
Emergency transport, small pneumothorax, and ambulation
Can go home with this
Drainage Systems (2)
Flutter valve connected to drainage bag
o For chronic pleural effusions and simple pneumothorax
Chest Drainage Units 3 compartments
o Collection chamber
Receives fluid and air
Fluid collects in collection chamber
Air travels to the water seal chamber
o Water Seal Chamber
2 cm water = one way valve
air moves from collection chamber water seal
chamber
Air bubbles up through the water
Initial brisk bubbling of air is normal after placement
Intermittent bubbling normal, expected
when breathing out, coughing or sneezing
increases = leak in system or from patient

Tidaling
Normal fluctuation of water during inspiration
and expiration
Stops when air leak seals and lung has
reexpanded
No tidaling when system attached to suction

o Suction Control Chamber applies suction to CDU. 2 types:


Water Suction
20 cm of water
top exposed to atmosphere
has bubbling when air enters from atmosphere
When excess suction is applied draws in air
through the top of the chamber and air bubbles
up through the water. (suction breaker effect)
To initiate suction:
o Vacuum source turned up until gentle
bubbling is present
o Excessive bubbling doesnt increase
suction, just makes water evaporate
faster
Dry Suction
No water
Visual alert indicates that suction is working
Turn dial on system to increase pressures
Nursing of CDUs
Never clamp
o Will cause tension pneumo
o Only to change system, check for leaks
o Clamped to assess how removal will be tolerated
Disconnection
o Reestablish water seal system immediately
o New system asap
o 2 cm sterile water until new system is connected
Monitor position and lung expansion with x-ray
Risk of infection at insertion site sterile dressing changes!
Removal
o By doctor
o Lungs have reexpanded
o Fluid isnt draining anymore
o Suction discontinued, drained by gravity for 24 hours
o Premedicate patient with pain meds

o Sterile airtight petroleum jelly dressing cover


immediately
o Tell patient to hold breath or bear down when removing
(valsalva)
o Chest x-ray afterwards, watch for respiratory distress
Look in medsurg book on p.572