CHEST TUBES A.Defintion 1. Use of tubes and suctionto return negative pressure to the intrapleural space. 2.

To drain air from the intrapleural space, the chest tube is placed in thesecond or third interscostal space. To drain fluid, the catheter would be placed at the catheter would be placed at a lower site, usually the eight or ninth intercostals space. B. Types of drainage systems 1. One-bottle underwater system: allows air or flui to drain from the pleural cavity by gravity via a glass ro, which extends approximately 2cm below the surface of the water within the collection bottle. 2. Two-bottle drainage system: involves one bottle that acts as a collection chamber and provides t6he water seal while a second bottle can be connectedto a suction apparatus, the bubbling of the water within the second bottle indicates that the desired suction is maintained. 3. Three-bottle system: includes one bottle that serves to collect drainage, one that acts as a water- seal chamber, and one that control suction. 4. Commercially preapred plastic unit: designed for closed tube suction: combines the features of the other systems and may or may not be attached to suction ( e.g. PleurEvac) C. Nursing Care 1. Ensure that the tubing is not kinked; tape all connections to prevent separation. 2. Gently milk the tubing if specifically ordered in the direction of the drainage system to maintain patency; milking can cause pnuemothorax. 3. Maintain the drainage system below the level of the ches 4. Turn the client frequently, Mking sure that the chest tube are not compresed. 5. Report drainage on dressing immiditely because this is not a normal occurence 6. Observe for fluctuation of fluid in tube; the level will rise in inhalation and fall on exhalation; if there are no fluctuations, either the lungs is expanded fully or the chest tube is clogged. 7. Palpate the area around the chest tube insertion site for subcutaneous emphysema or crepitus, which indicates the air is leaking into the subcutaneous tissue. 8. Situate the drainage bottle or Pleur Evac to avoid breakge 9. Place two clamps at he bedside for use if the under-water-seal bottle is broken; clamp the chest tube imediately to prevent air from entering

intrapleural space, which would cause pneumothorax to occur or extend; clamps are used judiciously and only in emergency situation. 10.Encourage coughing and deep breathing every two hours, splinting the area is need. 11.Instruct the client or to strain ( Valsalva Manuever) as the tube is wityhdrawn by the physician; apply a gauze dressing immediately and firmly secure with tape to make an airtightdressing. 12.Evaluate clients response to procedure

Prepared by: Kalista Mignnone I. Fidel,R.N. Clinical Instructor