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The primary goal of closed-chest drainage is to optimize ventilation and gas exchange by
draining the air or fluid from the pleural cavity. When the closed-chest drainage system is not
working properly, patients may show early signs of altered oxygenation, such as restlessness,
hyperventilation, and tachycardia. They may also report increased pain on the affected side. At
this point, it is essential to troubleshoot the equipment, quickly identify the problem, and provide
effective interventions.
Next,
determine
whether or
not there is
an air leak. If you see excessive and continuous
bubbling in the water-seal chamber or the air-leak
meter, especially if the system is connected to a
suction source, look for a leak in the drainage
system. Using rubber-tipped clamps, try to locate
the leak by clamping the tube momentarily at
various points along its length. Begin at the tube’s
proximal end, near the dressing. Look at the water-
seal/air-leak meter chamber. If the bubbling stops,
the air leak is at the chest-tube insertion site or
inside the chest. Examine the chest-tube insertion
site quickly to see if the dressing is loose or the
tube is dislodged. If the dressing is loose, air may
be entering around the tube as the patient inhales. Palpate around the chest tube site and listen
for a crackling sound indicating subcutaneous emphysema, which can result from a poor seal at
the chest-tube insertion site. Ask the patient to cough to rid the pleural space of as much air as
possible, apply an occlusive dressing or reinforce the dressing if it is intact, and monitor the
patient to see if oxygenation improves. The sound of hissing air, a large amount of new drainage
at the insertion site, or visibility of the drainage holes at the proximal end of the chest tube
suggest that the tube has dislodged. Notify the physician immediately and prepare for another
chest-tube insertion. Have emergency equipment (oxygen, resuscitation cart, chest- tube
insertion kit) nearby including a flutter (Heimlich) valve or a large-gauge needle for an
emergency thoracostomy.
If the bubbling continues after you clamp the tube momentarily near the insertion site, place
another clamp a little further down the tube about 20 to 30 cm (8 to 12 inches) toward the
drainage system and remove the first clamp. Each time you clamp at the more distal location,
check the water-seal/air-leak meter chamber. When you place a clamp between the source of
the air leak and the water-seal/air-leak meter, the bubbling will stop. That indicates a leak in the
tubing distal to the clamp. Replace the tubing or secure the connection and release the clamp. If
you clamp along the tube’s entire length and the bubbling doesn’t stop, the drainage unit might
be cracked and you will have to replace it.
MECHANISM:
In normal situations, the pressure between the pleura of the lungs is below atmospheric
pressure.
When air or fluid enters the intra pleural space, the pressure is altered, and this can cause
collapse of a portion of the lung
Even with adequate oxygenation and open airway, a patient with a collapsed portion of the lung
will not have adequate oxygen= carbon dioxide exchange
The only treatment for this altered condition is to restore the negative pressure to the
intrapleural space. This is accomplished through the use of chest tube.