fluid drains into chest tube via a 6' connecting tube, then into collection chamber.
Things to assess about the fluid in the collection chamber
amount, rate, characteristics of drainage; can usually get a sample out of most units collection chamber for labs
Collection chamber holds up to
acts as a one-way valve so air can drain from the chest cavity, but can't return to patient. Water seal evacuates air from chest & passes through a column and bubbles into the bottom of the water seal.
Analogy for water-seal chamber being a one-way valve
A cup of water with a straw in it: if you blow into the straw, air bubbles out through the water; if you try to draw air in, you get water.
suction control reuglator
water-filled or dry suction removes chest drainage & maintains flow.
How to regulate suction on CDU
connect CDU's vacuum line tubing to wall suction and set the CDU suction to the ordered level
First, the clinician will drape & prepare insertion site with povidine-iodine solution, then...
local anesthetic, incision, insert tube
Once tube has been inserted, what should you do before you start suction?
attach the patient-connecting tube to the drainage device and secure it to device with tape or whatever policy advises.
What is the CDU suction usually set at?
-20 cm H2O
Wall-suction needs to be set to at least what pressure?
-80 mmHg or greater (multiple drains like 2 mediastinal tubes require more vacuum)
Clinician will suture it place once unit is working properly, what should you dress the site with after they apply petrolatum gauze?
sterile split-drain sponges covered by sterile 4x4 gauze and secure with 2: tape
Patient will need chest x-ray to confirm placement. What do you document after confirmation?
assessments b4/after, chest tube size & insertion site, insertion date/time, who inserted it, whether drainage was present and the amount color & type; how pt. tolerated procedure; medications they received; results of xray; patient & family teaching
x-ray shows lungs have reexpanded, respiratory status normal, drainage over the last 24hrs. is < 100mL
Before removal of chest tube, what does the order "place the tube on water seal" mean?
discontinuing suction, usually 24 hours before anticipated removal. Watch for deterioration in respiratory status while his chest tube is on water seal (lung may not remain inflated or he can get another pneumothorax)
Nursing role/implementation during removal of chest tube
Explain procedure, premedicate 15 min prior. Instruct to take a deep breath and hold it when told to.
Once tube is removed, what type of dressing should be applied to site?
sterile, occlusive dressing. Observe patient for any changes in resp. status; get chest x-ray
immediately cover site (leave 2-3 sides open) with a dry, sterile dressing & call clinician
What if chest tube becomes disconnected from the CDU or CDU breaks?
submerge distal end in 1" of sterile 0.9% NaCl solution or sterile water to create a liquid seal while you prepare and attach a new CDU
When should the CDU be changed?
If it breaks or if it is full.
Steps to changing CDU units.
1. prepare new CDU unit 2. remove current CDU from suction, clamp chest tube w/ a rubber-tipped hemostat, disconnect connecting tube from CDU 3. Quickly connect new CDU, unclamp tube & secure all connections 4. Resume suction & make sure new unit is functioning normally