Chest Tube review

Chest Tubes
(f)x= to remove air/fluid from the pleural space. To re-expand the lungs.
Simple things to Remember
Normal breathing works on -neg- pressure.
Pressure in the chest cavity is lower than the pressure in the atmosphere--Air moves into the lungs during inspiration.
When the chest is open from surgery or trauma - pressure is lost and the lung can collapse.
Chest tubes drain fluid or gas. Normally 20mL in pleural space.
Pneumothorax= air in the pleural space. Common from surgery.
Hemothorax= blood or serous fluid in the pleural space. Both lead to a decrease in gas exchange.
The chest tube will restore the -neg-pressure needed.
Small bore chest tube--7F to 12F, has a one way valve that prevents the air from moving back to the patient.
Large bore tube--up to 40F. Usually connected to drainage.
Wet Water Seal- amount of suction made by the amount of water instilled in the suction chamber. The amount of bubbling tells how strong the suction is. The water seal prevents the water from being sucked back to the patient on inspiration.
When wall suction is off--must be open to air.
To prevent pneumothorax, tube can be placed in sterile water for a temporary water seal.
Leaks
To check @ insertion site= clamp briefly at site with padded hemostats. If the bubbling stops in the water seal chamber= Leak at insertion site.
To check tubing= pinch rubber connecting tubing. If bubbling stops=leak at connecting site.
The water seal chamber should not be bubbling. Small amount of bubbling when- suction starts, drainage displacement, or a cough displaces air.
Remember
Check q 15min-1 hour first day post operative.
Water Seal chamber should have 2cm tidaling water.
Suction control= 20cm H2O regulates amount of suction
Document the drainage. Do not empty drainage (MD)
Dislodged tube: Have patient exhale. Compress site and provide a tight seal. Apply occlusive dressing. Notify MD
Chest tube disconnected from site: Clamp tube with padded hemostats near the insertion site. Create and underwater seal.
And we know that we will be using a pleur-evac...but since they are still testing us on this old 3 bottle system....anyway good to know the system to understand the concept of the pleur-evac drainage/suction system.