The positions allowed and the amount of mobility permitted will depend on the patient's surgical diagnosis, the placement of the tube(s), and preference of the attending physician. Excessive bubbling may indicate air leaks in the tubing.Īn important aspect of patient care is proper positioning to maintain adequate drainage. The amount of air being removed is indicated by occasional bubbling in the water-seal chamber. The chest tubes should be milked and stripped every one to two hours to assure patency and adequate drainage. The amount, color, and consistency of the fluid drainage should be checked at least once each hour for the first 24 hours after surgery. There can be no leaks around connections, and the lower end of the glass tube must remain under water in the bottle. The system must be a closed (airtight) system. Occlusion of the tubes can lead to a buildup of air and fluids in the pleural cavity and creation of a tension pneumothorax.ģ. If there is evidence that the system is not working properly, this must be attended to immediately. ![]() ![]() In the Pleur-evac, the liquid in the chamber should rise on the right side and fall on the left side. If they are obstructed there will be no fluctuation of the fluid level in the glass tube that is connected to the chest tube at one end and kept under water in the bottle at the other end. The lumens of the tubes must be kept open to allow for drainage. The bottles and collection apparatus of the system must be kept below the level of the chest to prevent backflow.Ģ. Precautions that must be taken in the maintenance of the drainage system are:ġ. Whatever the type, the purpose of the system is to allow for drainage from the pleural cavity to the outside and at the same time prevent the entry of atmospheric air into the pleural cavity. ![]() In some cases one tube is inserted higher in the thorax (usually in the 2nd intercostal space) to remove air, and a second tube is placed lower (in the 8th or 9th intercostal space) to drain off fluids.Ĭhest tubes may be connected to a variety of closed drainage systems: a water-seal drainage system with one, two, or three bottles and a self-contained system such as Pleur-evac. It is important that those responsible for the personal care of a patient who has chest tubes inserted understand the basic mechanics of inflation and deflation of the lung, and the purpose of the tubes and their location in each patient.
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