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CHEST TUBES AND DRAINAGE SYSTEMS NURSING COMPETENCY

CHEST TUBES AND DRAINAGE SYSTEMS NURSING COMPETENCY. Presented by: Jonna Bobeck BSN, RN, CEN. Objectives. Discuss anatomy and physiology of chest Describe mechanics of breathing Explain indications/contraindications Discuss nursing care Describe set up and monitoring Understand water seal.

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CHEST TUBES AND DRAINAGE SYSTEMS NURSING COMPETENCY

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  1. CHEST TUBES AND DRAINAGE SYSTEMS NURSING COMPETENCY Presented by: Jonna Bobeck BSN, RN, CEN

  2. Objectives • Discuss anatomy and physiology of chest • Describe mechanics of breathing • Explain indications/contraindications • Discuss nursing care • Describe set up and monitoring • Understand water seal

  3. Introduction

  4. Anatomy of the Chest Visceral Pleura Parietal Pleura Lung Ribs Intercostal Muscles

  5. Why are the Lungs Expanded

  6. Mechanics of Breathing

  7. Indications: Pneumothorax/Hemothorax

  8. Indications: Tension Pneumothorax

  9. Indications: Other Conditions

  10. Contraindications and Cautions • Be aware of hemodynamic status • Use of a trocar • Pneumothorax and air transport

  11. How Water Seal Chest Drainage Units Functions

  12. Fluid Collection

  13. WATER SEAL • Safe • Cost effective • Measurement of intrathoracic pressure

  14. Suction Control

  15. Equipment

  16. PREPARATION AND INSERTION • IV, O2, Monitor • Proper cleansing • Place patient supine • Administer antibiotics • Prepare drainage device • Tape or band connections • Apply occlusive dressing • Obtain CXR • Monitor

  17. FOUR STEP SET UP: STEP 1

  18. STEP 2

  19. STEP 3

  20. STEP 4

  21. WHAT TO CHECK DURING SYSTEM OPERATION: SUCTION CONTROL STOPCOCK

  22. WHAT TO CHECK CONTINUED • Verifying system operation • Placement of unit

  23. PLACEMENT OF UNIT • Place below patient’s chest • Use floor stand or hangers

  24. OBSERVING FOR AIR LEAKS

  25. SAMPLING PATIENT DRAINAGE

  26. OBSERVING CHANGES IN PATIENT PRESSURE

  27. HIGH NEGATIVITY FLOAT VALVE

  28. MANUAL HIGH NEGATIVITY VENT

  29. WHAT TO CHECK CONTINUED • Positive pressure protection • Adding water to water seal • Adding water to suction control • Suction greater than -20cmH20 • How to lower suction control pressure setting • Recording drainage volume

  30. IN-LINE PATIENT TUBE CONNECTORS

  31. PATIENT TUBE CLAMP-

  32. GRAVITY DRAINAGE AND SYSTEM DISCONNECT • Placement • Stopcock • Close slide clamp

  33. AUTOTRANSFUSION CAPABILITY

  34. WARNINGS AND PRECAUTIONS • Colleceted blood should not remain in chest drain for more than 6 hours • Keep patient tube clamp open during operation • Purge all air/do not administer entire contents • Citrate toxicity • Use a microemboli filter • Use hangers • Maximum infusion pressure 150 mmHg

  35. SET UP ATS COLLECTION • Close chest drain ATS access line clamp and remove spike port cap. Insert ATS bag spike into access line of chest tube drainage system. • Position ATS bag below the base of the chest drain. • Open both clamps. Holding ATS bag below base of chest drain, bend ATS bag upward where indicated and it will pop open. Do not activate ATS bag prior to connecting chest drain. • When drainage has been collected Close ATS access line and ATS blood bag clamps. • Remove spike from ATS access line and recap ATS access line spike port and position access line in the holder located on top of the chest drain. • Keep ATS clamp fully closed at all time when not in use.

  36. ATS BAG REINFUSION SET UP • Prime I.V. blood administration and microemboli blood filter with sterile saline. • Invert ATS bag with spike port pointing upward and remove cap using sterile technique. • Insert saline filter spike into ATS bag spike port. • Return bag to upright position and place on standard height I.V. pole.

  37. TROUBLESHOOTING GUIDE • How to confirm airleak • Floatball is at the bottom of water seal column • Lowering water seal level • Water rises to the top of the water seal float valve • Tidaling of pressure ball

  38. TROUBLESHOOTING CONTINUED • No bubbling in the suction control chamber • Vigorous bubbling noted in the suction control • Should suction control valve be turned off for transport? • should the manual vent be used during gravity drainage? • What to do if drainage system gets knocked over

  39. UNEXPECTED OUTCOMES • Air leak • Mediastainal shift • Tube dislodgement • Substantial increase in bright red drainage • Loss of suction • Crepitus

  40. DOCUMENTATION • Patient and family education • Reason for tube • Assessment • Presence of fluctuation and bubbling • Amount of suction • Patient tolerance

  41. OMG! LOOK AT THAT OUTPUT!

  42. References • Atrium Medical Corporation, Initials. (2010). A personal guide to managing chest drainage. New Hampshire: Atrium Medical Corporation.

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